Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis

Objective: To investigate whether centralisation of acute stroke services in two metropolitan areas of England was associated with changes in mortality and length of hospital stay. Design: Analysis of difference-in-differences between regions with patient level data from the hospital episode statistics database linked to mortality data supplied by the Office for National Statistics. Setting: Acute stroke services in Greater Manchester and London, England. Participants: 258 915 patients with stroke living in urban areas and admitted to hospital in January 2008 to March 2012. Interventions “Hub and spoke” model for acute stroke care. In London hyperacute care was provided to all patients with stroke. In Greater Manchester hyperacute care was provided to patients presenting within four hours of developing symptoms of stroke. Main outcome measures Mortality from any cause and at any place at 3, 30, and 90 days after hospital admission; length of hospital stay. Results: In London there was a significant decline in risk adjusted mortality at 3, 30, and 90 days after admission. At 90 days the absolute reduction was −1.1% (95% confidence interval −2.1 to −0.1; relative reduction 5%), indicating 168 fewer deaths (95% confidence interval 19 to 316) during the 21 month period after reconfiguration in London. In both areas there was a significant decline in risk adjusted length of hospital stay: −2.0 days in Greater Manchester (95% confidence interval −2.8 to −1.2; 9%) and −1.4 days in London (−2.3 to −0.5; 7%). Reductions in mortality and length of hospital stay were largely seen among patients with ischaemic stroke. Conclusions: A centralised model of acute stroke care, in which hyperacute care is provided to all patients with stroke across an entire metropolitan area, can reduce mortality and length of hospital stay

Pair Creation of Black Holes by Domain Walls

In this paper we study the production of pairs of neutral and charged black holes by domain walls, finding classical solutions and calculating their classical actions. We find that neutral black holes whose creation is mediated by Euclidean instantons must be produced mutually at rest with respect to one another, but for charged black holes a new type of instanton is possible in which after formation the two black holes accelerate away from one another. These new types of instantons are not possible in Einstein-Maxwell theory with a cosmological constant. We also find that the creation of non-orientable black hole solutions can be mediated by Euclidean instantons and that in addition if one is prepared to consider entirely Lorentzian no-boundary type contributions to the path integral then mutually accelerating pairs may be created even in the neutral case. Finally we consider the production of Kaluza-Klein monopoles both by a standard cosmological term and in the presence of a domain wall. We find that compactification is accompanied by the production of pairs of Kaluza-Klein monopoles.Comment: 22 pages (REVTeX with AMS Symbols) with 5 postscript figures attached in a single uuencoded, g-zipped, tar file at end of tex fil

Effects of beta-alanine supplementation on brain homocarnosine/carnosine signal and cognitive function: an exploratory study

Objectives: Two independent studies were conducted to examine the effects of 28 d of beta-alanine supplementation at 6.4 g d-1 on brain homocarnosine/carnosine signal in omnivores and vegetarians (Study 1) and on cognitive function before and after exercise in trained cyclists (Study 2). Methods: In Study 1, seven healthy vegetarians (3 women and 4 men) and seven age- and sex-matched omnivores undertook a brain 1H-MRS exam at baseline and after beta-alanine supplementation. In study 2, nineteen trained male cyclists completed four 20-Km cycling time trials (two pre supplementation and two post supplementation), with a battery of cognitive function tests (Stroop test, Sternberg paradigm, Rapid Visual Information Processing task) being performed before and after exercise on each occasion. Results: In Study 1, there were no within-group effects of beta-alanine supplementation on brain homocarnosine/carnosine signal in either vegetarians (p = 0.99) or omnivores (p = 0.27); nor was there any effect when data from both groups were pooled (p = 0.19). Similarly, there was no group by time interaction for brain homocarnosine/carnosine signal (p = 0.27). In study 2, exercise improved cognitive function across all tests (P0.05) of beta-alanine supplementation on response times or accuracy for the Stroop test, Sternberg paradigm or RVIP task at rest or after exercise. Conclusion: 28 d of beta-alanine supplementation at 6.4g d-1 appeared not to influence brain homocarnosine/ carnosine signal in either omnivores or vegetarians; nor did it influence cognitive function before or after exercise in trained cyclists

Establishment of a consensus protocol to explore the brain pathobiome in patients with mild cognitive impairment and Alzheimer\u27s disease: Research outline and call for collaboration.

Microbial infections of the brain can lead to dementia, and for many decades microbial infections have been implicated in Alzheimer\u27s disease (AD) pathology. However, a causal role for infection in AD remains contentious, and the lack of standardized detection methodologies has led to inconsistent detection/identification of microbes in AD brains. There is a need for a consensus methodology; the Alzheimer\u27s Pathobiome Initiative aims to perform comparative molecular analyses of microbes in post mortem brains versus cerebrospinal fluid, blood, olfactory neuroepithelium, oral/nasopharyngeal tissue, bronchoalveolar, urinary, and gut/stool samples. Diverse extraction methodologies, polymerase chain reaction and sequencing techniques, and bioinformatic tools will be evaluated, in addition to direct microbial culture and metabolomic techniques. The goal is to provide a roadmap for detecting infectious agents in patients with mild cognitive impairment or AD. Positive findings would then prompt tailoring of antimicrobial treatments that might attenuate or remit mounting clinical deficits in a subset of patients

Evaluation of an Atmosphere Revitalization Subsystem for Deep Space Exploration Missions

An Atmosphere Revitalization Subsystem (ARS) suitable for deployment aboard deep space exploration mission vehicles has been developed and functionally demonstrated. This modified ARS process design architecture was derived from the International Space Station's (ISS) basic ARS. Primary functions considered in the architecture include trace contaminant control, carbon dioxide removal, carbon dioxide reduction, and oxygen generation. Candidate environmental monitoring instruments were also evaluated. The process architecture rearranges unit operations and employs equipment operational changes to reduce mass, simplify, and improve the functional performance for trace contaminant control, carbon dioxide removal, and oxygen generation. Results from integrated functional demonstration are summarized and compared to the performance observed during previous testing conducted on an ISS-like subsystem architecture and a similarly evolved process architecture. Considerations for further subsystem architecture and process technology development are discussed

Complete Genome Sequences of Chop, DelRio, and GrandSlam, Three Gordonia Phages Isolated from Soil in Central Arkansas

Chop, DelRio, and GrandSlam are phage with a Siphoviridae morphotype isolated from soil in Arkansas using the host Gordonia terrae 3612. All three are temperate, and their genomes share at least 96% nucleotide identity. These phage are assigned to cluster DI based on gene content similarity to other sequenced actinobacteriophage

Hydrothermal Alteration of Ultramafic Rocks in Ladon Basin, Mars—Insights From CaSSIS, HiRISE, CRISM, and CTX

The evolution of the Ladon basin has been marked by intense geological activity and the discharge of huge volumes of water from the Martian highlands to the lowlands in the late Noachian and Hesperian. We explore the potential of the ExoMars Trace Gas Orbiter/Color and Stereo Surface Imaging System color image data set for geological interpretation and show that it is particularly effective for geologic mapping in combination with other data sets such as HiRISE, Context, and Compact Reconnaissance Imaging Spectrometer for Mars. The study area displays dark lobate flows of upper Hesperian to early Amazonian age, which were likely extruded from a regional extensional fault network. Spectral analysis suggests that these flows and the underlying rocks are ultramafic. Two distinct altered levels are observed below the lobate flows. The upper, yellow-orange level shows hundreds of structurally controlled narrow ridges reminiscent of ridges of listwanite, a suite of silicified, fracture-controlled silica-carbonate rocks derived from an ultramafic source and from serpentine. In addition to serpentinite, the detected mineral assemblages may include chlorite, carbonates, and talc. Kaolin minerals are detected in the lower, white level, which could have formed by groundwater alteration of plagioclase in the volcanic pile. Volcanism, tectonics, hydrothermal activity, and kaolinization are interpreted to be coeval, with hydrothermal activity and kaolinization controlled by the interactions between the aquifer and the hot, ultramafic lobate flows. Following our interpretations, East Ladon may host the first listwanite ridges described on Mars, involving a hydrothermal system rooted in a Hesperian aquifer and affecting ultramafic rocks from a magmatic source yet to be identified

Detection and characterization of male sex chromosome abnormalities in the UK Biobank study

Purpose: The study aimed to systematically ascertain male sex chromosome abnormalities, 47,XXY (Klinefelter syndrome [KS]) and 47,XYY, and characterize their risks of adverse health outcomes. Methods: We analyzed genotyping array or exome sequence data in 207,067 men of European ancestry aged 40 to 70 years from the UK Biobank and related these to extensive routine health record data. Results: Only 49 of 213 (23%) of men whom we identified with KS and only 1 of 143 (0.7%) with 47,XYY had a diagnosis of abnormal karyotype on their medical records or self-report. We observed expected associations for KS with reproductive dysfunction (late puberty: risk ratio [RR] = 2.7; childlessness: RR = 4.2; testosterone concentration: RR = -3.8 nmol/L, all P < 2 x 10(-8)), whereas XYY men appeared to have normal reproductive function. Despite this difference, we identified several higher disease risks shared across both KS and 47,XYY, including type 2 diabetes (RR = 3.0 and 2.6, respectively), venous thrombosis (RR = 6.4 and 7.4, respectively), pulmonary embolism (RR = 3.3 and 3.7, respectively), and chronic obstructive pulmonary disease (RR = 4.4 and 4.6, respectively) (all P Conclusion: KS and 47,XYY were mostly unrecognized but conferred substantially higher risks for metabolic, vascular, and respiratory diseases, which were only partially explained by higher levels of body mass index, deprivation, and smoking. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics.Peer reviewe