Association between disability measures and healthcare costs after initial treatment for acute stroke

<p><b>Background and Purpose:</b> The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index.</p> <p><b>Methods:</b> We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures.</p> <p><b>Results:</b> We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1–2 to 3–4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs (£) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS.</p> <p><b>Conclusions:</b> Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.</p&gt

Nurturing lifelong learning in communities through the National University of Lesotho: prospects and challenges

This paper analyses one aspect of a pan-African action research project called ITMUA (Implementing the Third Mission of Universities in Africa). This particular paper draws on the data from that project to explore the National University of Lesotho’s contribution to lifelong learning in its communities. It provides background information on the ITMUA initiative and analyses interview and focus group responses to two case studies in terms of their contribution to lifelong learning. It uses, as its analytical framework, a modified version of Mbigi’s African perspective on the four De Lors’ ‘pillars’, by adding a fifth pillar, courtesy of Torres. The paper argues that community engagement is a two-way process between universities and their wider constituencies with opportunities for mutual lifelong learning. But there are also challenges of understanding and process which must be addressed if the full range of these lifelong learning pillars is to be accommodated within African contexts. The paper provides an introduction to the history of community engagement in Africa as a university mission, followed by a brief discussion of lifelong learning within African perspectives. After describing the particular context of Lesotho, the concept of community service and community engagement in contemporary African contexts introduces the action research project and the case studies. The final part of the paper presents and discusses the research findings

Occupational exposures to solvents and metals are associated with fixed airflow obstruction

peer-reviewedOur study is the first to investigate the associations between exposures to solvents and metals using lifetime work history calendars and fixed airflow obstruction (AO). We have shown that increasing cumulative exposure-unit years to chlorinated solvents is associated with fixed AO. We found that women were at increased risk of fixed AO with increasing cumulative exposed-unit-years to chlorinated solvents but not men

A joint geochemical–geophysical record of time-dependent mantle convection south of Iceland

The North Atlantic V-Shaped Ridges (VSRs) provide a spatially extensive and clear record of unsteady mantle convective circulation over >40 My>40 My. VSRs are diachronous ridges of thick crust formed with a periodicity of ∼5 My∼5 My along the Mid Atlantic Ridge, south of Iceland. We present data from a set of dredged basalt samples that shows chemical variation associated with two complete VSR crustal thickness cycles where they intersect the Mid Atlantic Ridge. The new dataset also records chemical variation associated with a VSR crustal thickness cycle along a plate spreading flow-line. Inverse correlations between crustal thickness and both incompatible trace element concentrations and incompatible element ratios such as Nb/Y and La/Sm are observed. Geochemical and crustal thickness observations can be matched using a time-dependent mid-ocean ridge melting model with a basal boundary condition of sinusoidally varying potential temperature. Our observations and models suggest that VSRs are generated when hot patches are carried up the plume stem beneath SE Iceland and spread radially outward within the asthenosphere. These patches are then drawn upward into the melting region when passing beneath the Mid Atlantic Ridge. The geometry of the VSRs and the size of the dynamically supported swell suggest that the Iceland Plume is the strongest plume in the Earth at present, with a volume flux of View the MathML source49±14 km3yr−1

Defining the impact of dietary macronutrient balance on PCOS traits

Lifestyle, mainly dietary, interventions are first-line treatment for women with polycystic ovary syndrome (PCOS), but the optimal diet remains undefined. We combined a hyperandrogenized PCOS mouse model with a systematic macronutrient approach, to elucidate the impact of dietary macronutrients on the development of PCOS. We identify that an optimum dietary macronutrient balance of a low protein, medium carbohydrate and fat diet can ameliorate key PCOS reproductive traits. However, PCOS mice display a hindered ability for their metabolic system to respond to diet variations, and varying macronutrient balance did not have a beneficial effect on the development of metabolic PCOS traits. We reveal that PCOS traits in a hyperandrogenic PCOS mouse model are ameliorated selectively by diet, with reproductive traits displaying greater sensitivity than metabolic traits to dietary mac ronutrient balance. Hence, providing evidence to support the development of evidence-based dietary interventions as a promising strategy for the treatment of PCOS, especially repro ductive traits.Valentina Rodriguez Paris, Samantha M. Solon-Biet, Alistair M. Senior, Melissa C. Edwards Reena Desai, Nicodemus Tedl

Low-energy structure of Mn61 populated following β decay of Cr61

β decay of the Cr6137 ground state has been studied. A new half-life of 233±11 ms has been deduced, and seven delayed γ rays have been assigned to the daughter Mn6136. The low-energy level structure of Mn6136 is similar to that of the less neutron-rich Mn57,59 nuclei. The odd-A25Mn isotopes follow the systematic trend in the yrast states of the even-even, Z+1 26Fe isotopes, and not that of the Z-1 24Cr isotopes, where a possible onset of collectivity has been suggested to occur already at N=36

In-beam γ-ray spectroscopy of Pt isotopes located at the proton drip line

In-beam g rays have been observed in the neutron-deficient isotopes 170,171,172Pt using the recoil-decay tagging technique. The yrast transition sequence proposed for 172Pt indicates that the 01 bandhead of the deformed intruder band is situated about 900 keV above the weakly deformed ground state, i.e., its excitation energy has risen by about 300 keV compared to 174Pt. The measured energy of the 21 !01 transition in 170Pt supports an even larger increase in the excitation energy of the intruder configuration with the departure from the middle of the 82–126 major neutron shell. Furthermore, a band with transition energies almost identical to those found in 172Pt has been assigned to 171Pt and was interpreted as corresponding to a rotationally aligned i13/2 neutron orbital coupled to the core excitations

Quantitative computed tomography predicts outcomes in idiopathic pulmonary fibrosis

First published: 25 July 2022Background and objective: Prediction of disease course in patients with progressive pulmonary fibrosis remains challenging. The purpose of this study was to assess the prognostic value of lung fibrosis extent quantified at computed tomography (CT) using data-driven texture analysis (DTA) in a large cohort of well-characterized patients with idiopathic pulmonary fibrosis (IPF) enrolled in a national registry. Methods: This retrospective analysis included participants in the Australian IPF Registry with available CT between 2007 and 2016. CT scans were analysed using the DTA method to quantify the extent of lung fibrosis. Demographics, longitudinal pulmonary function and quantitative CT metrics were compared using descriptive statistics. Linear mixed models, and Cox analyses adjusted for age, gender, BMI, smoking history and treatment with anti-fibrotics were performed to assess the relationships between baseline DTA, pulmonary function metrics and outcomes. Results: CT scans of 393 participants were analysed, 221 of which had available pulmonary function testing obtained within 90 days of CT. Linear mixed-effect modelling showed that baseline DTA score was significantly associated with annual rate of decline in forced vital capacity and diffusing capacity of carbon monoxide. In multivariable Cox proportional hazard models, greater extent of lung fibrosis was associated with poorer transplant-free survival (hazard ratio [HR] 1.20, p < 0.0001) and progression-free survival (HR 1.14, p < 0.0001). Conclusion: In a multi-centre observational registry of patients with IPF, the extent of fibrotic abnormality on baseline CT quantified using DTA is associated with outcomes independent of pulmonary function.Stephen M. Humphries, John A. Mackintosh, Helen E. Jo, Simon L. F. Walsh, Mario Silva, Lucio Calandriello, Sally Chapman, Samantha Ellis, Ian Glaspole, Nicole Goh, Christopher Grainge, Peter M. A. Hopkins, Gregory J. Keir, Yuben Moodley, Paul N. Reynolds, E. Haydn Walters, David Baraghoshi, Athol U. Wells, David A. Lynch, Tamera J. Cort

In-beam γ-ray spectroscopy of the proton emitter 147 69Tm using recoil-decay tagging

Gamma rays from the decay of states in the proton unstable nucleus 147Tm were observed for the first time following the 92Mo(58Ni,p2n! 147Tm reaction at 260 MeV. Prompt g rays were detected with an array of Compton-suppressed Ge detectors, placed in front of the fragment mass analyzer at the ATLAS accelerator, and were assigned to individual reaction channels on an event-by-event basis using the recoil-decay tagging method. Gamma-ray transitions were associated with both the proton decay of the ph11/2 ground state and the pd3/2 isomeric state in 147Tm, even though the cross sections for populating these states were only ' 16 mb and 2 mb, respectively. The level scheme which was constructed for 147Tm is discussed and compared with the level structures for lighter N578 isotones

J-Integral Calculation by Finite Element Processing of Measured Full-Field Surface Displacements

© 2017 The Author(s)A novel method has been developed based on the conjoint use of digital image correlation to measure full field displacements and finite element simulations to extract the strain energy release rate of surface cracks. In this approach, a finite element model with imported full-field displacements measured by DIC is solved and the J-integral is calculated, without knowledge of the specimen geometry and applied loads. This can be done even in a specimen that develops crack tip plasticity, if the elastic and yield behaviour of the material are known. The application of the method is demonstrated in an analysis of a fatigue crack, introduced to an aluminium alloy compact tension specimen (Al 2024, T351 heat condition)