Endovascular equipoise shift in a phase III randomized clinical trial of sonothrombolysis for acute ischemic stroke

Background: Results of our recently published phase III randomized clinical trial of ultrasound-enhanced thrombolysis (sonothrombolysis) using an operator-independent, high frequency ultrasound device revealed heterogeneity of patient recruitment among centers. Methods: We performed a post hoc analysis after excluding subjects that were recruited at centers reporting a decline in the balance of randomization between sonothrombolysis and concurrent endovascular trials. Results: From a total of 676 participants randomized in the CLOTBUST-ER trial we identified 52 patients from 7 centers with perceived equipoise shift in favor of endovascular treatment. Post hoc sensitivity analysis in the intention-to-treat population adjusted for age, National Institutes of Health Scale score at baseline, time from stroke onset to tPA bolus and baseline serum glucose showed a significant (p < 0.01) interaction of perceived endovascular equipoise shift on the association between sonothrombolysis and 3 month functional outcome [adjusted common odds ratio (cOR) in centers with perceived endovascular equipoise shift: 0.22, 95% CI 0.06–0.75; p = 0.02; adjusted cOR for centers without endovascular equipoise shift: 1.20, 95% CI 0.89–1.62; p = 0.24)]. After excluding centers with perceived endovascular equipoise shift, patients randomized to sonothrombolysis had higher odds of 3 month functional independence (mRS scores 0–2) compared with patients treated with tPA only (adjusted OR: 1.53; 95% CI 1.01–2.31; p = 0.04). Conclusion: Our experience in CLOTBUST-ER indicates that increasing implementation of endovascular therapies across major academic stroke centers raises significant challenges for clinical trials aiming to test noninterventional or adjuvant reperfusion strategies

The Impact of Family Financial Investment on Perceived Parent Pressure and Child Enjoyment and Commitment in Organized Youth Sport

Ninety percent of American youth participate in some form of organized youth sport between the ages of 5 and 18. Parent involvement in this context has recently been characterized as a potentially harmful force in parent–child relations, leading to debate regarding the appropriateness and level of parent involvement in organized youth sport. Despite the rising costs associated with youth sport participation, little empirical effort has been made to examine the potential impact of family financial investment on parent involvement and children\u27s subsequent sport outcomes. The purpose of this study was to address how family financial investment in youth sport influences children\u27s perceptions of parent pressure, sport enjoyment, and commitment to continued participation. Data from a national sample of 163 parent–child dyads illuminated an inverse association between family financial investment and child sport commitment, mediated by children\u27s perceptions of parent pressure and sport enjoyment. The results indicated that family financial investment predicts child commitment through the sequential mediators of perceived parent pressure and child enjoyment. These findings draw attention to many avenues for future research on the potential link among family investment decisions, parent involvement behaviors, and child outcomes in organized youth sport, which may collectively inform the development of parent interventions for youth sport leagues, administrators, and parents

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis

10.1097/HJH.0000000000002628JOURNAL OF HYPERTENSION392266-27

Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis

Background and purpose: Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. Methods: Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AIS patients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. Results: Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P < 0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P = 0.011) and 90-day mortality (P < 0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52–0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23–2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36 h after IVT administration. Conclusions: Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AIS patients treated with IVT

Risk Analysis and Bioeconomics of Invasive Species to Inform Policy and Management

Risk analysis of species invasions links biology and economics, is increasingly mandated by international and national policies, and enables improved management of invasive species. Biological invasions proceed through a series of transition probabilities (i.e., introduction, establishment, spread, and impact), and each of these presents opportunities for management. Recent research advances have improved estimates of probability and associated uncertainty. Improvements have come from species-specific trait-based risk assessments (of estimates of introduction, establishment, spread, and impact probabilities, especially from pathways of commerce in living organisms), spatially explicit dispersal models (introduction and spread, especially from transportation pathways), and species distribution models (establishment, spread, and impact). Results of these forecasting models combined with improved and cheaper surveillance technologies and practices [e.g., environmental DNA (eDNA), drones, citizen science] enable more efficient management by focusing surveillance, prevention, eradication, and control efforts on the highest-risk species and locations. Bioeconomic models account for the interacting dynamics within and between ecological and economic systems, and allow decision makers to better understand the financial consequences of alternative management strategies. In general, recent research advances demonstrate that prevention is the policy with the greatest long-term net benefit