Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom durationmodel, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration \u3e270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration \u3c6 \u3eh. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification

Product Service System Innovation in the Smart City

Product service systems (PSS) may usefully form part of the mix of innovations necessary to move society toward more sustainable futures. However, despite such potential, PSS implementation is highly uneven and limited. Drawing on an alternate socio-technical perspective of innovation, this paper provides fresh insights, on among other things the role of context in PSS innovation, to address this issue. Case study research is presented focusing on a use orientated PSS in an urban environment: the Copenhagen city bike scheme. The paper shows that PSS innovation is a situated complex process, shaped by actors and knowledge from other locales. It argues that further research is needed to investigate how actors interests shape PSS innovation. It recommends that institutional spaces should be provided in governance landscapes associated with urban environments to enable legitimate PSS concepts to co-evolve in light of locally articulated sustainability principles and priorities

Atmospheric extinction properties above Mauna Kea from the Nearby Supernova Factory spectro-photometric data set

We present a new atmospheric extinction curve for Mauna Kea spanning 3200--9700 \AA. It is the most comprehensive to date, being based on some 4285 standard star spectra obtained on 478 nights spread over a period of 7 years obtained by the Nearby SuperNova Factory using the SuperNova Integral Field Spectrograph. This mean curve and its dispersion can be used as an aid in calibrating spectroscopic or imaging data from Mauna Kea, and in estimating the calibration uncertainty associated with the use of a mean extinction curve. Our method for decomposing the extinction curve into physical components, and the ability to determine the chromatic portion of the extinction even on cloudy nights, is described and verified over the wide range of conditions sampled by our large dataset. We demonstrate good agreement with atmospheric science data obtain at nearby Mauna Loa Observatory, and with previously published measurements of the extinction above Mauna Kea.Comment: 22 pages, 24 figures, 6 table

Antiretroviral therapy to prevent HIV acquisition in serodiscordant couples in a hyperendemic community in rural South Africa

Background. Antiretroviral therapy (ART) was highly efficacious in preventing human immunodeficiency virus (HIV) transmission in stable serodiscordant couples in the HPTN-052 study, a resource-intensive randomized controlled trial with near-perfect ART adherence and mutual HIV status disclosure among all participating couples. However, minimal evidence exists of the effectiveness of ART in preventing HIV acquisition in stable serodiscordant couples in "real-life" population-based settings in hyperendemic communities of sub-Saharan Africa, where health systems are typically resource-poor and overburdened, adherence to ART is often low, and partners commonly do not disclose their HIV status to each other. Methods. Data arose from a population-based open cohort in KwaZulu-Natal, South Africa. A total of 17 016 HIV-uninfected individuals present between January 2005 and December 2013 were included. Interval-censored time-updated proportional hazards regression was used to assess how the ART status affected HIV transmission risk in stable serodiscordant relationships. Results. We observed 1619 HIV seroconversions in 17 016 individuals, over 60 349 person-years follow-up time. During the follow-up period, 1846 individuals had an HIV-uninfected and 196 had an HIV-infected stable partner HIV incidence was 3.8/100 person-years (PY) among individuals with an HIV-infected partner (95% confidence interval [CI], 2.3-5.6), 1.4/100 PY (.4-3.5) among those with HIV-infected partners receiving ART, and 5.6/100 PY (3.5-8.4) among those with HIV-infected partners not receiving ART. Use of ART was associated with a 77% decrease in HIV acquisition risk among serodiscordant couples (adjusted hazard ratio, 0.23; 95% CI,. 07-.80). Conclusions. ART initiation was associated with a very large reduction in HIV acquisition in serodiscordant couples in rural KwaZulu-Natal. However, this "real-life" effect was substantially lower than the effect observed in the HPTN-052 trial. To eliminate HIV transmission in serodiscordant couples, additional prevention interventions are probably needed

Standardizing Type Ia Supernova Absolute Magnitudes Using Gaussian Process Data Regression

We present a novel class of models for Type Ia supernova time-evolving spectral energy distributions (SED) and absolute magnitudes: they are each modeled as stochastic functions described by Gaussian processes. The values of the SED and absolute magnitudes are defined through well-defined regression prescriptions, so that data directly inform the models. As a proof of concept, we implement a model for synthetic photometry built from the spectrophotometric time series from the Nearby Supernova Factory. Absolute magnitudes at peak $B$ brightness are calibrated to 0.13 mag in the $g$-band and to as low as 0.09 mag in the $z=0.25$ blueshifted $i$-band, where the dispersion includes contributions from measurement uncertainties and peculiar velocities. The methodology can be applied to spectrophotometric time series of supernovae that span a range of redshifts to simultaneously standardize supernovae together with fitting cosmological parameters.Comment: 47 pages, 15 figures, accepted for publication by Astrophysical Journa

Host Galaxy Properties and Hubble Residuals of Type Ia Supernovae from the Nearby Supernova Factory

We examine the relationship between Type Ia Supernova (SN Ia) Hubble residuals and the properties of their host galaxies using a sample of 115 SNe Ia from the Nearby Supernova Factory (SNfactory). We use host galaxy stellar masses and specific star-formation rates fitted from photometry for all hosts, as well as gas-phase metallicities for a subset of 69 star-forming (non-AGN) hosts, to show that the SN Ia Hubble residuals correlate with each of these host properties. With these data we find new evidence for a correlation between SN Ia intrinsic color and host metallicity. When we combine our data with those of other published SN Ia surveys, we find the difference between mean SN Ia brightnesses in low and high mass hosts is 0.077 +- 0.014 mag. When viewed in narrow (0.2 dex) bins of host stellar mass, the data reveal apparent plateaus of Hubble residuals at high and low host masses with a rapid transition over a short mass range (9.8 <= log(M_*/M_Sun) <= 10.4). Although metallicity has been a favored interpretation for the origin of the Hubble residual trend with host mass, we illustrate how dust in star-forming galaxies and mean SN Ia progenitor age both evolve along the galaxy mass sequence, thereby presenting equally viable explanations for some or all of the observed SN Ia host bias.Comment: 20 pages, 11 figures, accepted for publication in Ap

Host Galaxies of Type Ia Supernovae from the Nearby Supernova Factory

We present photometric and spectroscopic observations of galaxies hosting Type Ia supernovae (SNe Ia) observed by the Nearby Supernova Factory (SNfactory). Combining GALEX UV data with optical and near infrared photometry, we employ stellar population synthesis techniques to measure SN Ia host galaxy stellar masses, star-formation rates (SFRs), and reddening due to dust. We reinforce the key role of GALEX UV data in deriving accurate estimates of galaxy SFRs and dust extinction. Optical spectra of SN Ia host galaxies are fitted simultaneously for their stellar continua and emission lines fluxes, from which we derive high precision redshifts, gas-phase metallicities, and Halpha-based SFRs. With these data we show that SN Ia host galaxies present tight agreement with the fiducial galaxy mass-metallicity relation from SDSS for stellar masses log(M_*/M_Sun)>8.5 where the relation is well-defined. The star-formation activity of SN Ia host galaxies is consistent with a sample of comparable SDSS field galaxies, though this comparison is limited by systematic uncertainties in SFR measurements. Our analysis indicates that SN Ia host galaxies are, on average, typical representatives of normal field galaxies.Comment: 25 pages, 13 figures, accepted for publication in Ap

Measuring cosmic bulk flows with Type Ia Supernovae from the Nearby Supernova Factory

Context. Our Local Group of galaxies appears to be moving relative to the cosmic microwave background with the source of the peculiar motion still uncertain. While in the past this has been studied mostly using galaxies as distance indicators, the weight of type Ia supernovae (SNe Ia) has increased recently with the continuously improving statistics of available low-redshift supernovae. Aims. We measured the bulk flow in the nearby universe ($0.015 < z < 0.1$) using 117 SNe Ia observed by the Nearby Supernova Factory, as well as the Union2 compilation of SN Ia data already in the literature. Methods. The bulk flow velocity was determined from SN data binned in redshift shells by including a coherent motion (dipole) in a cosmological fit. Additionally, a method of spatially smoothing the Hubble residuals was used to verify the results of the dipole fit. To constrain the location and mass of a potential mass concentration (e.g., the Shapley supercluster) responsible for the peculiar motion, we fit a Hubble law modified by adding an additional mass concentration. Results. The analysis shows a bulk flow that is consistent with the direction of the CMB dipole up to $z \sim 0.06$, thereby doubling the volume over which conventional distance measures are sensitive to a bulk flow. We see no significant turnover behind the center of the Shapley supercluster. A simple attractor model in the proximity of the Shapley supercluster is only marginally consistent with our data, suggesting the need for another, more distant source. In the redshift shell $0.06 < z < 0.1$, we constrain the bulk flow velocity to $< 240~\textrm{km s}^{-1}$ (68% confidence level) for the direction of the CMB dipole, in contradiction to recent claims of the existence of a large-amplitude dark flow.Comment: 12 pages, 5 figures, added corrigendum (http://adsabs.harvard.edu/abs/2015A%26A...578C...1F

SiFTO: An Empirical Method for Fitting SNe Ia Light Curves

We present SiFTO, a new empirical method for modeling type Ia supernovae (SNe Ia) light curves by manipulating a spectral template. We make use of high-redshift SN observations when training the model, allowing us to extend it bluer than rest frame U. This increases the utility of our high-redshift SN observations by allowing us to use more of the available data. We find that when the shape of the light curve is described using a stretch prescription, applying the same stretch at all wavelengths is not an adequate description. SiFTO therefore uses a generalization of stretch which applies different stretch factors as a function of both the wavelength of the observed filter and the stretch in the rest-frame B band. We compare SiFTO to other published light-curve models by applying them to the same set of SN photometry, and demonstrate that SiFTO and SALT2 perform better than the alternatives when judged by the scatter around the best fit luminosity distance relationship. We further demonstrate that when SiFTO and SALT2 are trained on the same data set the cosmological results agree.Comment: Modified to better match published version in Ap

Si/SiC bonded wafer: a route to carbon free SiO2 on SiC

This paper describes the thermal oxidation of Si/SiC heterojunction structures, produced using a layer-transfer process, as an alternative solution to fabricating SiC metal-oxide-semiconductor (MOS) devices with lower interface state densities (Dit). Physical characterization demonstrate that the transferred Si layer is relatively smooth, uniform, and essentially monocrystalline. The Si on SiC has been totally or partially thermally oxidized at 900–1150 °C. Dit for both partially and completely oxidized silicon layers on SiC were significantly lower than Dit values for MOS capacitors fabricated via conventional thermal oxidation of SiC. The quality of the SiO2, formed by oxidation of a wafer-bonded silicon layer reported here has the potential to realize a number of innovative heterojunction concepts and devices, including the fabrication of high quality and reliable SiO2 gate oxides