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Background: Utilization of oral anticoagulants for acute ischemic stroke (AIS) prevention in patients with atrial fibrillation (AF) increased in the United States over the last decade. Whether this increase has been accompanied by any change in AF prevalence in AIS at the population level remains unknown. The aim of this study is to evaluate trends in AF prevalence in AIS hospitalizations in various age, sex, and racial subgroups over the last decade. Methods: We used data contained in the 2010–2020 National Inpatient Sample to conduct a serial cross-sectional study. Primary AIS hospitalizations with and without comorbid AF were identified using International Classification of Diseases Codes. Joinpoint regression was used to compute annualized percentage change (APC) in prevalence and to identify points of change in prevalence over time. Results: Of 5,190,148 weighted primary AIS hospitalizations over the study period, 25.1% had comorbid AF. The age- and sex-standardized prevalence of AF in AIS hospitalizations increased across the entire study period 2010–2020 (average APC: 1.3%, 95% confidence interval (CI): 0.8–1.7%). Joinpoint regression showed that prevalence increased in the period 2010–2015 (APC: 2.8%, 95% CI: 1.9–3.9%) but remained stable in the period 2015–2020 (APC: –0.3%, 95% CI: –1.0 to 1.9%). Upon stratification by age and sex, prevalence increased in all age/sex groups from 2010 to 2015 and continued to increase throughout the entire study period in hospitalizations in men 18–39 years (APC: 4.0%, 95% CI: 0.2–7.9%), men 40–59 years (APC: 3.4%, 95% CI: 1.9–4.9%) and women 40–59 years (APC: 4.4%, 95% CI: 2.0–6.8%). In contrast, prevalence declined in hospitalizations in women 60–79 (APC: –1.0%, 95% CI: –0.5 to –1.5%) and women ⩾ 80 years over the period 2015–2020 but plateaued in hospitalizations in similar-aged men over the same period. Conclusion: AF prevalence in AIS hospitalizations in the United States increased over the period 2010–2015, then plateaued over the period 2015–2020 due to declining prevalence in hospitalizations in women ⩾ 60 years and plateauing prevalence in hospitalizations in men ⩾ 60 years. [ABSTRACT FROM AUTHOR]

Electronic Health Record (EHR) systems are often configured to address challenges and improve patient safety for persons with Parkinson's disease (PWP). For example, EHR systems can help identify Parkinson's disease (PD) patients across the hospital by flagging a patient's diagnosis in their chart, preventing errors in medication and dosing through the use of clinical decision support, and supplementing staff education through care plans that provide step-by-step road maps for disease-based care of a specific patient population. However, most EHR-based solutions are locally developed and, thus, difficult to scale widely or apply uniformly across hospital systems. In 2020, the Parkinson's Foundation, a national and international leader in PD research, education, and advocacy, and Epic, a leading EHR vendor with more than 35% market share in the United States, launched a partnership to reduce risks to hospitalized PWP using standardized EHR-based solutions. This article discusses that project which included leadership from physician informaticists, movement disorders specialists, hospital quality officers, the Parkinson's Foundation and members of the Parkinson's community. We describe the best practice solutions developed through this project. We highlight those that are currently available as standard defaults or options within the Epic EHR, discuss the successes and limitations of these solutions, and consider opportunities for scalability in environments beyond a single EHR vendor. The Parkinson's Foundation and Epic launched a partnership to develop best practice solutions in the Epic EHR system to improve safety for PWP in the hospital. The goal of the partnership was to create the EHR tools that will have the greatest impact on outcomes for hospitalized PWP. [ABSTRACT FROM AUTHOR]

Much of the existing research in distance education has focused on contrasting the outcomes between traditional face-to-face teaching and purely online courses, in which the entire course content is delivered online. However, research has not examined the effectiveness of hybrid-online courses, in which a combination of online delivery and face-to-face classroom teaching is used, especially in the context of marketing courses. This paper examines student experiences and learning outcomes in purely online and hybrid-online course formats. For both formats, student satisfaction is found to be affected by the course content, student-teacher communications, the use of effective learning tools, and the instructor. Improvements in perceived learning and course performance scores are observed for the hybrid-online format in the context of a qualitative marketing course while no such benefits are observed for a technical marketing course. The results indicate that the merits of different distance learning approaches need to be evaluated in the specific context of each course and that the benefits of integrating ace-to-face meetings into online marketing courses are course specific. (Contains 4 tables and 1 note.)

Simple Summary: Our study analyzed 138,151 radical cystectomy patient encounters to determine which patient and facility characteristics are associated with discharge home and discharge to continued rehabilitation facilities. We used multivariate logistic regression to statistically analyze these datapoints while controlling for other variables. We found that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance and open surgery are associated with Continued Rehabilitation Facility (CRF) discharge. Objective: To assess predictors of discharge disposition—either home or to a CRF—after undergoing RC for bladder cancer in the United States. Methods: In this retrospective, cohort study, patients were divided into two cohorts: those discharged home and those discharged to CRF. We examined patient, surgical, and hospital characteristics. Multivariable logistic regression models were used to control for selected variables. All statistical tests were two-sided. Patients were derived from the Premier Healthcare Database. International classification of disease (ICD)-9 (<2014), ICD-10 (≥2015), and Current Procedural Terminology (CPT) codes were used to identify patient diagnoses and encounters. The population consisted of 138,151 patients who underwent RC for bladder cancer between 1 January 2000 and 31 December 2019. Results: Of 138,151 patients, 24,922 (18.0%) were admitted to CRFs. Multivariate analysis revealed that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance are associated with CRF discharge. Rural hospital location, self-pay status, increased annual surgeon case, and robotic surgical approach are associated with home discharge. Conclusions: Several specific patient, surgical, and facility characteristics were identified that may significantly impact discharge disposition after RC for bladder cancer. [ABSTRACT FROM AUTHOR]

Background: The prevalence, incidence and risk factors of atrial fibrillation (AF) in a large, geographically and ethnically diverse cohort in the United States have not been fully described. Methods: We analyzed data from 173,099 participants of the All of Us Research Program recruited in the period 2017–2019, with 92,318 of them having electronic health records (EHR) data available, and 35,483 having completed a medical history survey. Presence of AF at baseline was identified from self-report and EHR records. Incident AF was obtained from EHR. Demographic, anthropometric and clinical risk factors were obtained from questionnaires, baseline physical measurements and EHR. Results: At enrollment, mean age was 52 years old (range 18–89). Females and males accounted for 61% and 39% respectively. Non-Hispanic Whites accounted for 67% of participants, with non-Hispanic Blacks, non-Hispanic Asians and Hispanics accounting for 26%, 4% and 3% of participants, respectively. Among 92,318 participants with available EHR data, 3,885 (4.2%) had AF at the time of study enrollment, while the corresponding figure among 35,483 with medical history data was 2,084 (5.9%). During a median follow-up of 16 months, 354 new cases of AF were identified among 88,433 eligible participants. Individuals who were older, male, non-Hispanic white, had higher body mass index, or a prior history of heart failure or coronary heart disease had higher prevalence and incidence of AF. Conclusion: The epidemiology of AF in the All of Us Research Program is similar to that reported in smaller studies with careful phenotyping, highlighting the value of this new resource for the study of AF and, potentially, other cardiovascular diseases. [ABSTRACT FROM AUTHOR]

This study compares the prevalence of suicide attempts among Muslims compared with other faith communities in the US. [ABSTRACT FROM AUTHOR]

• Application of AFFF has led to widespread detection of PFAS. • Site investigations have resulted in the generation of considerable amount of IDW. • IDW is impacted by varying levels of PFAS along with coexisting constituents. The historic use of aqueous film-forming foam (AFFF) has led to widespread detection of per- and polyfluoroalkyl substance (PFAS) in groundwater, soils, sediments, drinking water, wastewater, and receiving aquatic systems throughout the United States (U.S.). Prior to any remediation activities, in order to identify the PFAS-impacted source zones and select the optimum management approach, extensive site investigations need to be conducted. These site investigations have resulted in the generation of considerable amount of investigation-derived waste (IDW) which predominantly consists of well purging water and drill fluid, equipment washing residue, soil, drill cuttings, and residues from the destruction of asphalt and concrete surfaces. IDW is often impacted by varying levels of PFAS which poses a substantial challenge concerning disposal to prevent potential mobilization of PFAS, logistical complexities, and increasing requirement for storage as a result of accumulation of the associated wastes. The distinct features of IDW involve the intermittent generation of waste, substantial volume of waste produced, and the critical demand for onsite management. This article critically focuses on innovative technologies and approaches employed for onsite treatment and management of PFAS-impacted IDW. The overall objective of this study centers on developing and deploying end-of-life treatment technology systems capable of facilitating unrestricted disposal, discharge, and/or IDW reuse on-site, thereby reducing spatial footprints and mobilization time. [ABSTRACT FROM AUTHOR]

Background: We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease.Methods: Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI).Results: Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5-28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5-3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3-26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2-43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients' county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1-8.1).Conclusions: Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

Objective: Oral anticoagulation treatment (OAT) resumption is a therapeutic dilemma in intracerebral hemorrhage (ICH) care, particularly for lobar hemorrhages related to amyloid angiopathy. We sought to determine whether OAT resumption after ICH is associated with long-term outcome, accounting for ICH location (ie, lobar vs nonlobar).Methods: We meta-analyzed individual patient data from: (1) the multicenter RETRACE study (n = 542), (2) a U.S.-based single-center ICH study (n = 261), and (3) the Ethnic/Racial Variations of Intracerebral Hemorrhage study (n = 209). We determined whether, within 1 year from ICH, OAT resumption was associated with: (1) mortality, (2) favorable functional outcome (modified Rankin Scale = 0-3), and (3) stroke incidence. We separately analyzed nonlobar and lobar ICH cases using propensity score matching and Cox regression models.Results: We included 1,012 OAT-related ICH survivors (633 nonlobar and 379 lobar). Among nonlobar ICH survivors, 178/633 (28%) resumed OAT, whereas 86/379 (23%) lobar ICH survivors did. In multivariate analyses, OAT resumption after nonlobar ICH was associated with decreased mortality (hazard ratio [HR] = 0.25, 95% confidence interval [CI] = 0.14-0.44, p < 0.0001) and improved functional outcome (HR = 4.22, 95% CI = 2.57-6.94, p < 0.0001). OAT resumption after lobar ICH was also associated with decreased mortality (HR = 0.29, 95% CI = 0.17-0.45, p < 0.0001) and favorable functional outcome (HR = 4.08, 95% CI = 2.48-6.72, p < 0.0001). Furthermore, OAT resumption was associated with decreased all-cause stroke incidence in both lobar and nonlobar ICH (both p < 0.01).Interpretation: These results suggest novel evidence of an association between OAT resumption and outcome following ICH, regardless of hematoma location. These findings support conducting randomized trials to explore risks and benefits of OAT resumption after ICH. Ann Neurol 2017;82:755-765. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate predictors and clinical relevance of heterotopic ossification (HO) in patients treated for acetabular fractures in a tertiary referral centre. Patients and methods: The study is a retrospective cohort study with a nested case–control study. All patients treated with internal fixation of acetabular fractures from January 2004 to October 2013. Ninety patients had postoperative imaging available at 6 and 12 months postoperatively and received no prophylaxis. Plain radiographs were used to grade HO. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to compare outcomes between patients suffering from HO with patients who did not. Results: Sixteen patients (17.7%) suffered from HO. According to the Brooker classification, 5 had class I, 4 class II, 3 class III and 4 class IV HO. Traumatic brain injury (TBI) was the only significant risk factor for developing HO (odds ratio (OR) 8.6, 95% confidence interval (CI) (1.693-43.753), p = 0.014). The HO rate in patients with an anterior (ilioinguinal) or posterior (Kocher-Langenbeck) surgical approach was 20% and 21% respectively, and the HO rate in patients with a combined approach was much lower at 11%. Neither fracture type nor gender nor age increased the risk of HO significantly. The outcome measured by HOOS was not significantly different between patients with HO and patients in the control group. Patients with HO Brooker class II-IV had slightly lower (effect estimate +4.25, 95% CI (−10.2 to +12.10), p = 0.220) HOOS compared to the majority of the control group. Conclusion: A very low rate of HO was found compared to the HO rates described in other studies with similar patient cohorts who received prophylaxis. Based on our findings and the current literature, we do not recommend giving prophylaxis against HO to patients after internal fixation of acetabular fractures. [ABSTRACT FROM AUTHOR]

The prevalence of metabolic syndrome (MS) has been rising alarmingly worldwide, including in the United States, but knowledge on specific genetic determinants of MS is very limited. Therefore, we planned to identify the genetic determinants of MS as defined by National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) criteria. We performed linkage screen for MS using data from 692 Mexican Americans, who participated in the San Antonio Family Diabetes/Gallbladder Study (SAFDGS). We found strong evidence for linkage of MS on chromosome 7q (LOD = 3.6, empirical P = 6.0 × 10-5), between markers D7S2212 and D7S821. In addition, six chromosomal regions exhibited potential evidence for linkage (LOD ≥1.2) with MS. Furthermore, we examined 29 single-nucleotide polymorphisms (SNPs) from the fatty acid translocase (FAT or CD36, 18 SNPs) gene and guanine nucleotide binding protein, α transducing 3 (GNAT3, 11 SNPs) gene, located within the 1-LOD support interval region for their association with MS and its related traits. Several SNPs were associated with MS and its related traits. Remarkably, rs11760281 in GNAT3 and rs1194197 near CD36 exhibited the strongest associations with MS (P = 0.0003, relative risk (RR) = 1.6 and P = 0.004, RR = 1.7, respectively) and several other related traits. These two variants explained ~18% of the MS linkage evidence on chromosome 7q21, and together conferred approximately threefold increase in MS risk (RR = 2.7). In conclusion, our linkage and subsequent association studies implicate a region on chromosome 7q21 to influence MS in Mexican Americans. [ABSTRACT FROM AUTHOR]

Purpose – The growing volume of consumer transactions in used products markets has given rise to strategic decisions made by sellers in the amount of information disclosed on usage-based attributes – product attributes that quantify the degree by which a product has been used. This paper seeks to address this issue. Based on the phenomenon referred to as the dilution effect, it is proposed that sellers would have less desire to disclose usage-based attribute information in product advertisements for older products. The effects of usage-based attributes on asking prices of used products are also examined and profiled across time and contrasted across three countries: Britain, Canada, and the USA. Design/methodology/approach – Used product advertisements were obtained for 1995 (USA) and 2010 (USA, Canada, and Britain). The ratio of ad content dedicated to usage-based attributes was then computed and profiled across various conditions, and variations were tested using statistical methods. Findings – The results indicate that a dilution-based strategy, whereby usage-based product information is less likely to be disclosed for older products, was evident in 1995 as it was in 2010. Furthermore, cross-country variations were observed in the use of this strategy. Research limitations/implications – The research presented can be expanded to cover other product categories where used products are exchanged and usage-based attributes constitute a fundamental consumer consideration in such exchanges. The research can also be extended to cover a wider range of countries for analysis. Originality/value – This paper extends traditional pricing theory to consider the effects of usage-based attributes on used product prices and associated consumer communications. Given the growth in the volume of consumer transactions in used product markets, this line of inquiry is relevant not only from an academic perspective but can also inform public policy and potential regulatory measures. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this article is to conduct a formal study of how the prices for online MBA programs in the USA are determined. The paper examines the effects of perceptual (e.g. rankings and accreditation) and structural characteristics (e.g. program length, program format) of online MBA programs on tuition levels charged. Design/methodology/approach – Publicly available secondary data from a sample of 115 online MBA programs in the USA, including program characteristic information and prices, is used. Regression analysis is used to uncover the underlying pricing model. Findings – Perceptual variables are found to have significantly greater effect on prices charged than structural variables, at times enabling institutions to nearly double their revenue stream on a per-student basis. Research limitations/implications – The research approach can be extended to uncover the pricing models used in distance learning programs in fields other than business, and to examine such relationships outside the scope of American institutions. Originality/value – The use of distance learning methods for delivering course instruction in degree-granting institutions has witnessed significant growth over the last decade. This trend has enhanced the ability of business schools to serve students that are geographically dispersed, and today nearly 400 such programs are offered in the USA alone. Despite the growth, no formal study has examined how prices (tuition levels) for such programs are determined. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Glucokinase (GCK) and glucose-6-phosphatase catalytic subunit 2 (G6PC2) regulate the glucose-cycling step in pancreatic β-cells and may regulate insulin secretion. GCK rs1799884 and G6PC2 rs560887 have been independently associated with fasting glucose, but their interaction on glucose-insulin relationships is not well Characterized. RESEARCH DESIGN AND METHODS--We tested whether these variants are associated with diabetes-related quantitative traits in Mexican Americans from the BetaGene Study and attempted to replicate our findings in Finnish men from the METabolic Syndrome in Men (METSIM) Study. RESULTS--rs1799884 was not associated with any quantitative trait (corrected P > 0.1), whereas rs560887 was significantly associated with the oral glucose tolerance test 30-min incremental insulin response (30′ Δinsulin, corrected P = 0.021). We found no association between quantitative traits and the multiplicative interaction between rs1799884 and rs560887 (P > 0.26). However, the additive effect of these single nucleotide polymorphisms was associated with fasting glucose (corrected P = 0.03) and 30′ Δinsulin (corrected P = 0.027). This additive association was replicated in METSIM (fasting glucose, P = 3.5 x 10[sup -10] 30′ Δinsulin, P = 0.028). When we examined the relationship between fasting glucose and 30′ Δinsulin stratified by GCK and G6PC2, we noted divergent changes in these quantitative traits for GCK but parallel changes for G6PC2. We observed a similar pattern in METSIM. CONCLUSIONS--Our data suggest that variation in GCK and G6PC2 have additive effects on both fasting glucose and insulin secretion. Diabetes 58:2946-2953, 2009 [ABSTRACT FROM AUTHOR]

This article reports on a national survey of university faculty members in the United States regarding the factors that influence their purchases of scholarly books. In total, 233 faculty members from eleven disciplines in more than fifty universities were surveyed. The survey gauged the impact of a series of factors that influence scholarly book purchases for research and teaching. In addition, sources of information used to locate scholarly books of interest were identified and contrasted across fields of study. The survey also examined trends in the respondents’ book-buying behaviour, their propensity to purchase used books, and the frequency with which they used university library systems to obtain access to scholarly books. [ABSTRACT FROM AUTHOR]

Background: Asian Indians display a high prevalence of diseases linked to changes in diet and environment that have arisen as their lifestyle has become more westernized. Using 1200 genome-wide polymorphisms in 432 individuals from 15 Indian language groups, we have recently shown that: (i) Indians constitute a distinct population-genetic cluster, and (ii) despite the geographic and linguistic diversity of the groups they exhibit a relatively low level of genetic heterogeneity. Results: We investigated the prevalence of common polymorphisms that have been associated with diseases, such as atherosclerosis (ALOX5), hypertension (CYP3A5, AGT, GNB3), diabetes (CAPN10, TCF7L2, PTPN22), prostate cancer (DG8S737, rs1447295), Hirschsprung disease (RET), and age-related macular degeneration (CFH, LOC387715). In addition, we examined polymorphisms associated with skin pigmentation (SLC24A5) and with the ability to taste phenylthiocarbamide (TAS2R38). All polymorphisms were studied in a cohort of 576 India-born Asian Indians sampled in the United States. This sample consisted of individuals whose mother tongue is one of 14 of the 22 "official" languages recognized in India as well as individuals whose mother tongue is Parsi, a cultural group that has resided in India for over 1000 years. Analysis of the data revealed that allele frequency differences between the different Indian language groups were small, and interestingly the variant alleles of ALOX5 g.8322G>A and g.50778G>A, and PTPN22 g.36677C>T were present only in a subset of the Indian language groups. Furthermore, a latitudinal cline was identified both for the allele frequencies of the SNPs associated with hypertension (CYP3A5, AGT, GNB3), as well as for those associated with the ability to taste phenylthiocarbamide (TAS2R38). Conclusion: Although caution is warranted due to the fact that this US-sampled Indian cohort may not represent a random sample from India, our results will hopefully assist in the design of future studies that investigate the genetic causes of these diseases in India. Our results also support the inclusion of the Indian population in disease-related genetic studies, as it exhibits unique genotype as well as phenotype characteristics that may yield new insights into the underlying causes of common diseases that are not available in other populations. [ABSTRACT FROM AUTHOR]

What was the market for university press books in the United States between 1997 and 2002? What impact did shifts in the general reader market and the creation of library electronic reserve capabilities have on university press net publishers' revenues? What impact did Internet bookselling sites have on new and used frontlist titles? The study reported here reviewed the published literature and statistical data sets. We detected (a) a significant shift in the traditional channels of distribution and (b) the emergence of a sophisticated used book market that undermined both frontlist and backlist sales. Based on a review of the empirical data, we present a series of recommendations for the university press community designed to capitalize on the inherent competitive advantages of university presses. [ABSTRACT FROM AUTHOR]

Ground observation absence in many parts of the world highlights the importance of merged satellite precipitation products. In this study, we aim to evaluate the effect of different sources of data in the uncertainties of a merged satellite product, by comparing the Integrated Multi-satellitE Retrievals for GPM (IMERG) Final product (V06B) with a ground-based radar product, Multi-Radar Multi-Sensor (MRMS), using both pixel-based and object-based approaches. This study is focused on the eastern United States (land-only) during the hurricane days that occurred in 2016–2018. The results showed that IMERG had better agreement in terms of the average precipitation intensity and area with a bias reduction of 75% and 65%, respectively, when the passive microwave (PMW) sensor overpass is matched instantaneously with MRMS compared to temporally averaged MRMS data (MRMS-Averaged). PMW observations tend to show storms with smaller areas in the IMERG Final product in comparison with MRMS, possibly due to the effect of light precipitation not detected properly by PMW sensors. However, by removing the light precipitation (less than 1 mm/h) in the object-based approach, hurricane objects in the IMERG Final product tend to be larger during the PMW observations, which might be related to different viewing angles of sensors contributing to MRMS and IMERG products. Precipitation estimates have smaller areas with higher average intensity during the PMW observations in the IMERG Final product compared to data estimated by Morphed or IR (morph/IR) observations, which is probably related to the effect of morphing technique, leading to homogenization of the varying rainstorm characteristics. In addition, with the longer absence of PMW observations, the quality of morph/IR estimates in IMERG Final product deteriorates with a decreasing correlation coefficient, a growth in precipitation area and a downward trend in average precipitation intensity. Finally, the inter-comparison of PMW sensors showed the priority of imagers over sounders with GMI as the best among imagers and MHS as the best among sounders in terms of correlation and average intensity compared to MRMS; however, SSMIS was the best in capturing the precipitation area. • PMW estimates in IMERG have better agreement with MRMS when matched instantaneously. • PMW sensors often represent the storms with smaller areas in IMERG compared to MRMS. • PMW sensors show the storms smaller with higher intensity compared to morphed/IR • Morphed/IR data quality in IMERG decreases with the longer absence of PMW sensors. • PMW sensors in IMERG should be prioritized based on the precipitation properties. [ABSTRACT FROM AUTHOR]

The article discusses a study of the national trends in ambulance use (AU) by patients with stroke in the U.S. from 1997 to 2008, using the data collected by the National Hospital Ambulatory Medical Care Survey. The researchers examined trends within groups of patients with a primary diagnosis of ischemic stroke and those with subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack, defined by characteristics such as age, sex, race and stroke subtype. They found that the proportion of patients with stroke who arrived at the emergency department via ambulance did not change between 1997 and 2008.

This Viewpoint reviews evidence of the benefits of thrombectomy for patients with ischemic stroke due to large vessel occlusion, and details the systems of care that need to be developed to ensure that all patients who might benefit from the procedure can be rapidly identified, transported, imaged, and treated under the care of qualified specialists. [ABSTRACT FROM AUTHOR]

Background: The risk of arterial thromboembolism in patients with cancer is incompletely understood.Objectives: The authors aimed to better define this epidemiological relationship, including the effects of cancer stage.Methods: Using the Surveillance Epidemiology and End Results-Medicare linked database, the authors identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 to 2011. They were individually matched by demographics and comorbidities to a Medicare enrollee without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics. Cox hazards analysis was used to compare rates between groups at discrete time points.Results: The authors identified 279,719 pairs of patients with cancer and matched control patients. The 6-month cumulative incidence of arterial thromboembolism was 4.7% (95% confidence interval [CI]: 4.6% to 4.8%) in patients with cancer compared with 2.2% (95% CI: 2.1% to 2.2%) in control patients (hazard ratio [HR]: 2.2; 95% CI: 2.1 to 2.3). The 6-month cumulative incidence of myocardial infarction was 2.0% (95% CI: 1.9% to 2.0%) in patients with cancer compared with 0.7% (95% CI: 0.6% to 0.7%) in control patients (HR: 2.9; 95% CI: 2.8 to 3.1). The 6-month cumulative incidence of ischemic stroke was 3.0% (95% CI: 2.9% to 3.1%) in patients with cancer compared with 1.6% (95% CI: 1.6% to 1.7%) in control patients (HR: 1.9; 95% CI: 1.8 to 2.0). Excess risk varied by cancer type (greatest for lung), correlated with cancer stage, and generally had resolved by 1 year.Conclusions: Patients with incident cancer face a substantially increased short-term risk of arterial thromboembolism. [ABSTRACT FROM AUTHOR]

Abstract: Current US building codes impose restrictions on the yield stress of steel bars used as longitudinal reinforcement in concrete columns. This paper revisits the origins of these restrictions and investigates the feasibility of using yield stress in excess of 80ksi (550MPa) to reduce the amounts of reinforcement required in structures to resist seismic loads. Analytical data from hypothetical cross sections and experimental data from tests are used to demonstrate that for columns with axial loads below the balanced point, the reduction in longitudinal reinforcement is not associated with reductions in strength and limiting curvature. The analytical and experimental results indicate that the reinforcement in a column can be decreased in direct proportion to an increase in yield stress. The evidence presented supports the hypothesis that for columns with low axial load, the use of high-strength bars can lead to reductions in congestion without critical consequences in performance. [Copyright &y& Elsevier]

Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop focused on identifying key research priorities related to AF screening. Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: (1) role of opportunistic screening; (2) AF as a risk factor, risk marker, or both; (3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; (4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and (5) role of AF screening after ischemic stroke. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF. [ABSTRACT FROM AUTHOR]

Background and purpose To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States. Methods The authors performed a retrospective cohort study of all patients 18 years or older hospitalized for tuberculous meningitis in California between 2005 and 2010, New York between 2006 and 2012, and Florida between 2005 and 2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan–Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities. Results 806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5–59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0–20.0%), the rate of seizure was 18.8% (95% CI, 15.4–22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4–10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5–25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9–9.4%). The mortality rate was 21.5% (95% CI, 18.4–24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9–1.6). Conclusions Tuberculous meningitis is associated with significant risk of neurological complications and death in the United States. [ABSTRACT FROM AUTHOR]

Objectives: We assessed recent trends in both urinary diversion after radical cystectomy for bladder cancer in the United States and patient- and hospital-related characteristics. We also identified variables associated with undergoing continent diversion.Materials and Methods: We queried the National Cancer Database and identified 27,170 patients who underwent radical cystectomy with urinary diversion from 2004 to 2013. Patient demographics, socioeconomic variables, and hospital-related factors were compared between incontinent and continent diversion and trended over time. Multivariable logistic regression was used to identify variables associated with undergoing continent diversion.Results: Overall, 23,224 (85.5%) and 3,946 (14.5%) patients underwent incontinent and continent diversion, respectively. Continent diversion declined from 17.2% in 2004 to 2006 to 12.1% in 2010 to 2013 (P < 0.01). When analyzing high-volume facilities, those performing ≥75% minimally invasive radical cystectomy had fewer continent diversions (10.2%) compared to centers with higher rate of open approach (19.7%), P < 0.01. Higher income, facility located in the West, academic programs, high-volume facilities, and patients traveling >60 miles for care were significantly associated with undergoing continent diversion. Rate of continent diversion has declined in most patient- and hospital-related subgroups. Compared to 2004 to 2006, patients in 2010 to 2013 were more likely to be older, have more comorbidities, and be operated on at a high-volume academic facility.Conclusion: The rate of continent diversion has declined to 12.1% in the United States. Hospital volume and type, patient income, distance traveled for care, and geography are significantly associated with undergoing continent diversion. Even among high-volume and academic centers, the rate of continent diversion is declining. [ABSTRACT FROM AUTHOR]