Abstract WP105: A Practical Wake up Tpa Protocol at a United States Based Comprehensive Stroke Center Hub and Its Telestroke Spokes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Navdeep S Sangha ◽  
Duy Le ◽  
Raeesa Dhanji ◽  
Denise Gaffney ◽  
David McCartney ◽  
...  
Keyword(s):  
United States ◽  
Small Sample Size ◽  
Statistical Significance ◽  
The United States ◽  
Small Sample ◽  
The Difference ◽  
Waking Up ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Main Barrier

Background: IV tPA is established as an effective treatment for acute ischemic stroke. Currently it is endorsed up to 4.5 hours of last known well time by major guidelines. A randomized trial, WAKE-UP, displayed its safety and efficacy in patients who presented within 4.5 hours of waking up with their symptoms. Objective: To establish a practical tPA protocol for patients who wake up or are found with stroke symptoms at a large Comprehensive Stroke Center (CSC) and its 13 telestroke spokes (TS) based on the WAKE-UP trial. Methods: A wake up tPA protocol was created and given to all teleneurologists. Door to needle times (DTN) and reasons for no tPA were collected for 12 months post implementation and evaluated for differences between wake up (WU) and non-wake up (NW) patients. Results: 93 WU patients were identified; 23 at CSC and 70 at TS. 11 (47.8%) vs. 4 (5.7%) patients received tPA at CSC and TS, respectively. Median DTN was not significantly different for WU patients at CSC vs. TS (64 vs. 89 mins, p=0.54). Median DTN at CSC was shorter for NW vs. WU (37 vs. 64 mins; p=0.003). Similarly, median DTN at TS trended toward being shorter for NW vs. WU (44 vs. 89 mins; p=0.062). The reasons for no tPA at CSC were no mismatch found in 6 (50%), and MRI unavailability in 6 (50%); at TS were no mismatch found in 11 (16.6%), MRI unavailability in 54 (81,1%) and MRI was contraindicated in 1 (1.5%). Conclusion: Treating WU patients using a CSC Hub and TS model is feasible. DTN are longer for WU vs. NW. In the United States, MRI availability is the main barrier to WU tPA at both CSC and community hospitals. The difference between median DTN for WU between CSC and TS did not reach statistical significance, likely due to the small sample size.

Trends in glassy cell cervical cancer in the United States from 1973-2015: Analysis based on SEER database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17502-e17502
Author(s):  
Anahat Kaur ◽  
Shuai Wang ◽  
Tarek N. Elrafei ◽  
Lewis Steinberg ◽  
Abhishek Kumar
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Small Sample Size ◽  
Black Population ◽  
The United States ◽  
Small Sample ◽  
Cervix Uteri ◽  
Kaplan Meier

e17502 Background: Glassy cell carcinoma of cervix (GCCC) is a rare histological subtype of cervical cancer which has historically been associated with rapidly progressive disease, early development of metastases and overall poor prognosis. We attempt to define real-world trends in GCCC in the United States based on data from SEER (Surveillance, Epidemiology and End Results) database. Methods: We extracted data from the US National Cancer Institute's SEER 2018 dataset using ICD-O code for ‘Cervix Uteri Glassy Cell Carcinoma’. All patients who were diagnosed between 1973-2015 were included. Statistical analysis was done using SPSS 26. Kaplan Meier curve was used for survival analysis. Results: Data for a total of 57 patients with GCCC was available from 1975 to 2017. Median age at diagnosis was 38 years (range 30.5-44.5). Increased frequency of cases was noted in white females (77.2%) as compared to black population (22.2%). Most cases initially presented with localized or regional spread (47.4% and 40.4% respectively) with distant metastasis seen in only 10.5% patients. Data analysis revealed that 63.2% patients had Grade III poorly differentiated carcinoma, 66.7% received radiation therapy, 57.9% underwent chemotherapy and 59.6% had cancer direceted surgery performed. Calculated mean overall survival was 121.9 months. We were unable to calculate 5 year and 10 year median overall survival due to small sample size and censored data. Conclusions: GCCC is a rare histologic type of cervical cancer that presents at a younger age, is more frequently seen in white females and is commonly associated with localized or regional spread at time of initial presentation.[Table: see text]

scholarly journals Head-Down Tilt Bed Rest Studies as a Terrestrial Analog for Spaceflight Associated Neuro-Ocular Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Joshua Ong ◽  
Andrew G. Lee ◽  
Heather E. Moss
Keyword(s):  
United States ◽  
Experimental Model ◽  
Space Flight ◽  
Visual Loss ◽  
Small Sample Size ◽  
Bed Rest ◽  
The United States ◽  
Small Sample ◽  
Preventative Measures ◽  
Ocular Changes

Astronauts who undergo prolonged periods of spaceflight may develop a unique constellation of neuro-ocular findings termed Spaceflight Associated Neuro-Ocular Syndrome (SANS). SANS is a disorder that is unique to spaceflight and has no terrestrial equivalent. The prevalence of SANS increases with increasing spaceflight duration and although there have been residual, structural, ocular changes noted, no irreversible or permanent visual loss has occurred after SANS, with the longest spaceflight to date being 14 months. These microgravity-induced findings are being actively investigated by the United States' National Aeronautics Space Administration (NASA) and SANS is a potential obstacle to future longer duration, manned, deep space flight missions. The pathophysiology of SANS remains incompletely understood but continues to be a subject of intense study by NASA and others. The study of SANS is of course partially limited by the small sample size of humans undergoing spaceflight. Therefore, identifying a terrestrial experimental model of SANS is imperative to facilitate its study and for testing of preventative measures and treatments. Head-down tilt bed rest (HDTBR) on Earth has emerged as one promising possibility. In this paper, we review the HDTBR as an analog for SANS pathogenesis; the clinical and imaging overlap between SANS and HDTBR studies; and potential SANS countermeasures that have been or could be tested with HDTBR.

Sex Differences in Birth Order of Alcoholics

1971 ◽  
Vol 119 (553) ◽  
pp. 657-661 ◽  
Author(s):  
Howard T. Blane ◽  
Herbert Barry ◽  
Herbert Barry
Keyword(s):  
United States ◽  
Sex Differences ◽  
Birth Order ◽  
Statistical Significance ◽  
The United States ◽  
Small Samples ◽  
Male And Female ◽  
Large Sample ◽  
The Difference

Studies of birth order of male alcoholics, reviewed by Chen and Cobb (1960), Sampson (1965), and Barry, Barry, and Blane (1969), generally showed more last-born than first-born cases. This difference was found in samples of more than 500 cases hospitalized in Denmark (Martensen-Larsen, 1957); Austria (Navratil, 1959); Canada (de Lint, 1964b), and Norway (Steén, 1966). Most samples in the United States have shown the same trend but with smaller numbers of cases, so that the difference was short of statistical significance. Ambiguous results have been obtained from the few studies of birth order of female alcoholics, generally based on small samples. The present paper reports on the birth-order distributions of a relatively large sample of male and female out-patient alcoholics in the United States.

Abstract P822: In-Hospital Stroke Treated With IV tPA at a Comprehensive Stroke Center Compared to Primary Stroke Centers Pre and Post Telestroke Implementation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Manya Khrlobyan ◽  
Jiaxiao M Shi ◽  
Zahra Ajani ◽  
Duy Le ◽  
Pamela Cheng ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Small Sample Size ◽  
Small Sample ◽  
Complication Rates ◽  
Recognition Time ◽  
Chi Square ◽  
Wilcoxon Rank Sum Test ◽  
Delayed Recognition ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: In-hospital strokes (IHS) often have delayed recognition time and a delay in physician assessment, playing a role in unfavorable outcomes. Telestroke (TS) participation is linked to lower odds of hospital mortality and is safe and effective in treating acute ischemic stroke. We implemented a TS program for IHS patients at primary stroke centers (PSC) and assessed tPA time metrics, complications and 90-day functional outcomes as compared to a robust in hospital stroke system of care at a comprehensive stroke center (CSC). Methods: Using a network database, data for all in-hospital code strokes were retrospectively abstracted between 2010-2020 at a CSC and 11 PSC’s. The CSC was compared to PSC’s pre and post implementation of a TS program. Data were analyzed using Wilcoxon rank-sum test, chi-square and exact tests. Results: We identified 193 patients, 77 at the CSC, 71 at pre-tele PSC’s, and 45 at post-tele PSC’s. Symptom-recognition-time (SRT) to neurology evaluation (median 15min {IQR 10-27} vs 75min {IQR 45-126, p=<0.0001) and SRT to IV t-PA (median 65min {IQR 46-91} vs 94min {IQR 73-112}, p=<0.001) were all faster at the CSC vs pre-tele PSC’s. There was no difference in rate of complications (p=0.05). When stroke mimics were excluded, CSC patients had a favorable 90-day mRS of 0-1 (24 patients, 35% vs 11 patients, 19%, p=0.04). After implementation of TS at PSC’s, there was no difference in tPA time metrics, except SRT to neurology evaluation remained faster at CSC (median 15min {IQR 10-27} vs 31min {IQR 18.5-52.5}, p=0.0002). There was no difference in rate of complications (p=0.21) and mRS at 90 days (p=0.82). Conclusions: Implementation of a TS program for IHS at PSC’s may improve tPA time metrics and 90 functional outcomes to the standards of CSC’s without increasing complication rates. Our study was limited by retrospective design and small sample size.

An electrophoretic study of representatives of subgenus Diploxylon of Pinus

1989 ◽  
Vol 67 (6) ◽  
pp. 1750-1759 ◽  
Author(s):  
Roopa R. Karalamangala ◽  
Daniel L. Nickrent
Keyword(s):  
United States ◽  
Cluster Analysis ◽  
Phylogenetic Trees ◽  
Small Sample Size ◽  
The United States ◽  
Small Sample ◽  
Genetic Affinity ◽  
Electrophoretic Study ◽  
Isozyme Loci

Relationships among 14 taxa in subgenus Diploxylon of Pinus from Mexico and the United States were analyzed using 15 isozyme loci obtained from both frozen and fresh needle tissue. The phenogram obtained from cluster analysis of genetic distance values and phylogenetic trees implementing the distance Wagner procedure were in general agreement with classifications based on morphological features. Pinus leiophylla is genetically distinct from other species. Two groupings, one comprising P. oocarpa and P. pringlei and another comprising P. lawsonii and P. teocote, correspond to sections Serotinus and Teocote (sensu Martínez), respectively. Classification of the remaining eight taxa has varied, ranging from their placement in three, two, or only one section. Isozyme analysis resulted in a group that included P. cooperi, P. douglasiana, P. durangensis, P. michoacana, and P. montezumae, which suggests genetic affinity between Sections Pseudostrobus and Montezumae (sensu Martínez). This result corresponds more closely to the placement of these species in subsection Pseudostrobi. The distant relationship between P. engelmannii and the ponderosa pines may be anomalous (an artifact of small sample size) or may indicate greater genetic divergence than previously recognized.

scholarly journals A visit to the stroke belt of the United States

2012 ◽  
Vol 03 (03) ◽  
pp. 426-428
Author(s):  
Lokesh Bathala
Keyword(s):  
United States ◽  
Recurrent Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
The United States ◽  
Southeastern Part ◽  
Stroke Treatment ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Diagnostic Catheter ◽  
Stroke Belt

ABSTRACTSoutheastern part of United States has been called the Stroke Belt due to a much higher incidence of stroke compared to the rest of the country. In this article, I summarize my 2 weeks of observations as a clinical preceptor at the Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL. 57 patients were admitted during these 2 weeks, 61% had ischemic strokes, and 23% received intravenous recombinant tissue plasminogen activator (IV rt-PA). Endovascular neuro-interventionalists were performing diagnostic catheter angiography in 14% and emergent revascularization procedures in 7% of consecutive patients. Also, the stroke team enrolled 6 patients into National institute of health (NIH) funded clinical trials (3 Argatroban tPA stroke study (ARTSS), 2 Safety study of external counter pulsation as a treatment for acute ischemic stroke (CUFFS), 1 stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS). In my opinion, these observations provided me with useful knowledge how to develop a cutting edge, proactive stroke treatment system. In particular, availability 24 × 7 and consistent application of a curative, “finding reasons to treat approach” coupled with state-of the-art technologies and skilled operators could make a huge difference.

scholarly journals Moral Rights Laws and Income Disparity Between Artists in High and Low GDP States

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Victoria Avanesov ◽  
Robert Hodgson
Keyword(s):  
United States ◽  
Statistical Significance ◽  
Well Being ◽  
The United States ◽  
T Test ◽  
Data Availability ◽  
Moral Rights ◽  
Difference In Differences ◽  
The Difference ◽  
The Impact

The United States' laissez-faire approach to moral rights legislation has left many academics questioning the impact that these laws have on artists' welfare. In using artists' income as one component of measuring overall well-being, states with additional statewide moral rights legislation have been shown to contribute to more significant artist losses, in contrast to states with only federal legislation. At the same time, moral rights laws have been shown to have no impact on artists' choice of residency, leaving some artists possibly disadvantaged regarding their choice of residency. Utilizing a difference in differences framework, this paper explores the impact of moral rights legislation on artists' weekly incomes between moral rights states of varying outputs of GDP. Although results suggested that artists would lose approximately $0.18 per one billion dollar increase in GDP at the statewide level, after conducting an additional t-test, these findings were shown to have no statistical significance. Several limitations, most prominently a lack of data availability in the pre-law values required for the difference in differences framework, may have contributed to these findings. These indeterminate results leave the question of whether some artists remain economically disadvantaged as a result of moral rights legislation uncertain.  

Abstract WP124: Ataste 2: Assessment of Anti-Hypertensive Treatment and Acute Stroke Treatment Efficiency 2

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Brian Sorace ◽  
Brett Meyer ◽  
Dawn Meyer ◽  
Kunal Agrawal
Keyword(s):  
Small Sample Size ◽  
Small Sample ◽  
Stroke Treatment ◽  
Significant Difference ◽  
Blood Pressures ◽  
Pre Treatment ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Cerebral Reperfusion ◽  
Iv Tpa

Introduction: Treatment of acute ischemic stroke (AIS) with tPA must be rapid for timely cerebral reperfusion. Anti-hypertensive (AHT) medication may be required to lower blood pressures prior to tPA. Optimal AHT use and its impact on tPA times is unclear. We examined treatment with IV bolus only (IVB), IV continuous infusion only (IVCI), or both bolus and infusion (BBI) AHTs on door-to-needle time (DTN) in AIS patients eligible for IV tPA. We hypothesized that 1) DTN would be significantly longer in patients requiring IV AHT before treatment and 2) DTN would be significantly lower in patients treated with IVCI compared to IVB or BBI. Methods: We analyzed all stroke codes who received IV tPA at our comprehensive stroke center from July 1, 2008 to June 30, 2019. Subjects were grouped by those that required IV AHT prior to IV tPA (med+tPA) and those that did not (no-med+tPA). The three medication groups were IVB, IVCI, or BBI. Variables examined were initial and immediate pre-treatment blood pressures, NIHSS, mRS, and initial blood glucose. The primary outcome was DTN between groups. Results: Overall, 288 patients were included in the analysis. Approximately 12% (n=35) of patients required IV AHTs before tPA. There was a significant difference between the med+tPA and no-med+tPA groups in 1) median NIHSS (12.5, 10; p=0.040) and initial mean glucose (142, 122.5; p&lt;0.001), respectively. DTN was significantly longer in med+tPA vs no-med+tPA mean (77.5 min, 56.4 min; p=0.036). Systolic blood pressures (SBP) were significantly higher in patients requiring AHT treatment (initial SBP: med+tPA 175.5 mmHg, no-med-tPA 144.1 mmHg, p=0.001). There was no difference in DTN between IVB, IVCI, or BBI groups when compared to the no-med+tPA group (p=0.351, 1.000, & 0.997). There was no difference in the 90-day mRS between IVB, IVCI, or BBI compared to control (p=0.236, 0.339, & 0.326). Conclusions: Fewer patients required AHT than expected suggesting lower rates of baseline hypertension in our region. Type of AHT agent used did not significantly impact DTN. This may be due to the small sample size of patients receiving blood pressure medication prior to tPA in this study. Further prospective studies are needed to examine the optimal AHT treatment modality on DTN.

scholarly journals Acid Suppressing Medication Use in Infants in the United States, 2002-2018

2020 ◽  
Author(s):  
michael e johansen
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Sample Size ◽  
Small Sample Size ◽  
Medication Use ◽  
The United States ◽  
Demographic Characteristics ◽  
Small Sample ◽  
Uptake Inhibitors ◽  
Race Ethnicity

Introduction: I attempted to determine rates of use and associations with use of acid-suppressing medications in infants under 2 years old given these are not well studied. Methods: The 2002-2018 Medical Expenditure Panel Survey (MEPS) was used for the analysis. The survey is sponsored by the Agency of Healthcare Research and Quality and is conducted on households to be nationally representative of the non-institutionalized population of the United States. The survey is comprised of two overlapping panels that are each included in the survey for two years. Newborns and infants under 2 years old on December 31 of a survey year were included in the study. Additionally, adult men and women living in the same household between 18-45 years old were considered fathers and mothers of infants. Histamine2-receptor antagonists (H2RA) and proton pump inhibitors (PPI) were identified for infants. H2RA, PPIs, and anti-depressant (selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors) were identified for parents. Sex, age (by month for child), race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, or other), region (Northeast, Midwest, South, and West), and poverty category were identified. Chi-squared and adjusted Wald tests were used to determine statistical significance with acid-suppressing medication use between 2010-2018. A multivariable logistic regression predicted any acid suppressing medication use with month of age and month of age2 as independent variables of use for the population between 2009-2018. The study was considered exempt by the OhioHealth Institutional Review Board. Survey weighting was included in all analyses. Results: The study included a total of 16,604 infants between 2002-2018. The rate of any acid suppressing medication increased between 2002-2004. H2RA use was more common than PPI use, especially after 2012. H2RA use appeared to increase after 2015. PPI use initially increased, but then remained relatively stable before appearing to decrease in 2015-2018. Ranitidine clearly had the most users of the H2RA, which was maintained throughout the study period. Lansoprazole had the most users among users of PPIs, but this decreased notably after 2010. Of the infants with a reported PPI, 34.0% (95%CI:23.6-46.3) also had an H2RA reported during the year. In total, 40.8% (95%CI:35.0-46.8) had only 1 reported fill of an acid suppresser. There were 8,075 infants under 2 years of age between 2010-2018. The rate of use was highest in infants between 4-11 months of age at the end of the survey year at 8.6% (95%CI:6.9-10.6). Acid-suppressing medication use was more common among infants in higher income families, White (non-Hispanic) race/ethnicity, infants with private health insurance, parents who reported acid-suppressing medication, maternal anti-depressant use, and certain regions of the country. Discussion: Between 6.9-10.6% of infants used an acid suppressing medication before their second birthday between 2010-2018, of which around 60% had multiple medication fills. It appears that there has been a small increases in use over the last few decades, of which ranitidine appears to be the medication driving the increase. Numerous socio-economic and demographic characteristics were associated with acid suppressing medication use. This study has numerous limitations, including potential under-reporting of acid-suppressing medications, an imperfect identification of parent, unreliable diagnoses (not included in the analysis), and a relatively small sample size. We opted not to run a multivariable logistic regression of socio-economic and demographic characteristics given concern for table 2 fallacy and relatively small sample size. Acid suppressing medication use was common in infants before their second birthday. Additional research should be conducted on efficacy and safety of these medications given the level of use and very low quality of available evidence.

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