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Understanding the environmental mechanisms that govern population change is a fundamental objective in ecology. Although the determination of how top-down and bottom-up drivers affect demography is important, it is often equally critical to understand the extent to which, environmental conditions that underpin these drivers fluctuate across time. For example, associations between climate and both food availability and predation risk may suggest the presence of trophic interactions that may influence inferences made from patterns in ecological data. Analytical tools have been developed to account for these correlations, while providing opportunities to ask novel questions regarding how populations change across space and time. Here, we combine two modeling disciplines-path analysis and mark-recapture-recovery models-to explore whether shifts in sea-surface temperatures (SSTs) influenced top-down (entanglement in fishing equipment) or bottom-up (forage fish production) population constraints over 60 years, and the extent to which these covarying processes shaped the survival of a long-lived seabird, the Royal tern. We found that hemispheric trends in SST were associated with variation in the amount of fish harvested along the Atlantic coast of North America and in the Caribbean, whereas reductions in forage fish production were mostly driven by shifts in the amount of fish harvested by commercial fisheries throughout the North Atlantic the year prior. Although the indirect (i.e., stock depletion) and direct (i.e., entanglement) impacts of commercial fishing on Royal tern mortality has declined over the last 60 years, increased SSTs during this time period has resulted in a comparable increase in mortality risk, which disproportionately impacted the survival of the youngest age-classes of Royal terns. Given climate projections for the North Atlantic, our results indicate that threats to Royal tern population persistence in the Mid-Atlantic will most likely be driven by failures to recruit juveniles into the breeding population.

Glacier surges produce iconic valley-scale folds which encode a history of polyphase deformation resulting from switches between quiescent and surging flow. The folding is passive, resulting from disturbances to ice foliation during surging flow, and subsequently altered during quiescent flow. We investigate the kinematic evolution of these kilometre-scale folds, using Elmer/Ice, by modelling folds through multiple surge cycles using idealized synthetic glacier confluence configurations, and identifying how differences in glacier flow regimes imprint themselves onto three-dimensional fold geometry. The surge and quiescent phases are simulated by changing the basal conditions of one of the tributaries, and matching the scale of velocity variations observed in temperate glacier surges. We determine fold geometry using a particle tracking algorithm applied to the modelled velocity fields, where, mimicking a medial moraine, vertically-spaced particles are injected at the flow unit confluence and advected downglacier. Using structural analysis of the model outputs, we present an archetype of kinematic evolution that describes the transition from cylindrical, vertically plunging, gentle folds emplaced during the surge phase, to complex, non-cylindrical, depth-varying folds following multiple cycles of surging and quiescent flow. The initial fold geometry is controlled by longitudinal and lateral shear stress regimes during surging, while fold evolution is governed primarily by lateral shearing after emplacement. We examine the sensitivity of fold geometry to valley geometry, glacier dynamics, and mass balance. Finally, we illustrate the potential of our approach to reconstruct more complex fold geometries as observed in nature, by applying it to a large surge-type glacier in the St. Elias Mountains of Northern Canada.

Aim: To explore prospective donors' attitudes and perceptions toward donating hematopoietic stem cells (HSCs) for novel treatments research and development (R&D). Methods: A survey was launched by Anthony Nolan (AN) to assess prospective donors' willingness to donate HSCs for novel therapies R&D, and their degree of comfort with the AN collaborating with and receiving payment from external organizations. Results: Most participants (87%) were willing to donate for novel treatment R&D and were comfortable with AN collaborating with external organizations and receiving payment (91% and 80%, respectively). Conclusion: Results reveal an overall positive response toward donating HSCs for R&D. These findings can support stakeholders and policymakers in outlining donation practices that uphold donors' safety and welfare.

Population declines of disturbance-dependent species due to suppression of natural disturbances are realized across ecosystems. The piping plover (Charadrius melodus; plover), a disturbance-dependent and conservation-reliant shorebird that nests on sandy beaches and barrier islands on the Atlantic Coast, was listed under the United States Endangered Species Act in 1986. In 2012, Hurricane Sandy landed on Fire and Westhampton islands, barrier island nesting sites for plovers in New York, USA. Hurricane Sandy was a natural disturbance in this system, creating abundant nesting habitat. The number of chicks produced by a pair, or a population, is a direct measure of reproductive output, and gaining a better understanding of productivity and chick behavior following large-scale habitat creation may improve plover habitat management and potentially species persistence. We evaluated the effects of landscape features on habitat selection, behavior, and survival of plover broods using logistic regression, generalized linear mixed effects models, and survival models. Plover broods selected flatter sites with less dense vegetation than available at random. Chick foraging rates were highest in moist substrates and were lower in areas of higher nesting plover density. Chick survival was greater for broods that hatched earlier in the breeding season and increased as chicks aged. Generally, providing access to sites with flatter, moist substrates will likely result in higher quality brood rearing habitat on the landscape. Ultimately, vegetation removal and habitat management may be needed to reduce plover nesting density and ensure sufficient habitat, which may in turn improve plover chick survival. Moreover, sustaining natural landscape disturbances such as those resulting from storms, and not taking actions to prevent hurricane-created overwash, will allow these landscape features to persist. U.S. Fish and Wildlife Service [F15AC00393, F13AC00194]; U.S. Army Corps of Engineers [W16R0E30650111] Published version U.S. Fish and Wildlife Service, Grant/Award Numbers: F15AC00393, F13AC00194; U.S. Army Corps of Engineers, Grant/Award Number: W16R0E30650111

OBJECTIVE Perfusion imaging identifies anterior circulation stroke patients who respond favorably to endovascular thrombectomy (ET), but its role in basilar artery occlusion (BAO) is unknown. We hypothesized that BAO patients with limited regions of severe hypoperfusion (time to reach maximum concentration in seconds [Tmax] > 10) would have a favorable response to ET compared to patients with more extensive regions involved. METHODS We performed a multicenter retrospective cohort study of BAO patients with perfusion imaging prior to ET. We prespecified a Critical Area Perfusion Score (CAPS; 0-6 points), which quantified severe hypoperfusion (Tmax > 10) in cerebellum (1 point/hemisphere), pons (2 points), and midbrain and/or thalamus (2 points). Patients were dichotomized into favorable (CAPS ≤ 3) and unfavorable (CAPS > 3) groups. The primary outcome was a favorable functional outcome 90 days after ET (modified Rankin Scale = 0-3). RESULTS One hundred three patients were included. CAPS ≤ 3 patients (87%) had a lower median National Institutes of Health Stroke Scale score (NIHSS; 12.5, interquartile range [IQR] = 7-22) compared to CAPS > 3 patients (13%; 23, IQR = 19-36; p = 0.01). Reperfusion was achieved in 84% of all patients, with no difference between CAPS groups (p = 0.42). Sixty-four percent of reperfused CAPS ≤ 3 patients had a favorable outcome compared to 8% of nonreperfused CAPS ≤ 3 patients (odds ratio [OR] = 21.0, 95% confidence interval [CI] = 2.6-170; p 3 patients had a favorable outcome, regardless of reperfusion. In a multivariate regression analysis, CAPS ≤ 3 was a robust independent predictor of favorable outcome after adjustment for reperfusion, age, and pre-ET NIHSS (OR = 39.25, 95% CI = 1.34->999, p = 0.04). INTERPRETATION BAO patients with limited regions of severe hypoperfusion had a favorable response to reperfusion following ET. However, patients with more extensive regions of hypoperfusion in critical brain regions did not benefit from endovascular reperfusion. ANN NEUROL 2021.

Designing wildflower habitats to support beneficial insects providing pollination and pest control services is important for supporting sustainable crop production. It is often desirable to support both groups of insects, making the selection of resource plants for insect conservation programs more challenging. Moreover, the process of selecting resource plants is complicated by the array of possible options in each region, and the need to provide resources over the entire growing season. Identifying traits shared by resource plants that are attractive to both bees and natural enemies can reduce the need to evaluate new plants in each region, by providing a guide for the types of plants expected to be rewarding to these insects. Using insect visitation data collected from replicated common garden plantings of native wildflower and shrub species from the Great Lakes region of the United States, we found a high degree of correlation between the abundance of bees and natural enemies visiting native plant species. These results were used to identify a set of 15 plant species that can provide resources for these insects throughout the summer. Across all tested species, pollen quantity per flower and the week of bloom were positively correlated with some, but not all, taxonomic groupings of beneficial insects. In contrast, floral area was consistently positively associated with visitation of both natural enemies and wild bees. This trait is easy to document and can allow for efficient local testing of potential resource plants, providing a faster path to implementing insect conservation in working landscapes.

We thank the Editors of JNIS for alerting us in advance to the concerns about SELECT2 raised by Jadhav1 and colleagues and appreciate the opportunity to explain the rationale for the study design and clarify the benefits of including perfusion imaging-based selection criteria. We are confident that SELECT2 will provide high-level, reliable data regarding the safety and efficacy of endovascular thrombectomy (EVT) for large core patients. The choice of imaging modality for identifying large core in acute ischemic stroke remains an area of considerable debate. Magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI), computed tomography (CT) or MR perfusion imaging and Alberta Stroke Program Early CT Score (ASPECTS) have all been proposed and studied. At present, there is no clear consensus on which imaging modality is best for identifying patients with large core. It is important to recognize that the early window randomized EVT trials used a broad range of imaging selection criteria. The imaging selection criteria for the initial five pivotal trials ranged from allowing patients to be enrolled regardless of the degree of early infarct signs,2 to studies that required a specific ASPECTS score range in addition to other imaging criteria,3–5 to EXTEND IA6 where the ASPECTS score was not considered, and CT perfusion (CTP) mismatch with a maximum estimated core size was required. All five trials were successful but with substantial variability in the treatment effect, leaving uncertainty as to the optimal imaging approach as well as whether there are patient subgroups who do not benefit. In fact, those utilizing perfusion mismatch criteria (EXTEND-IA, SWIFT PRIME) had higher rates of modified Rankin Scale (mRS) scores 0–2 and larger treatment effects, compared with other trials.2–6 Even if a treatment has a clear benefit in most patients, there can be important subgroups that do not …

Epistaxis is common, impacting more than half the population, and can require procedural intervention in approximately 10% of cases. With an aging population and increasing use of antiplatelets and anticoagulants, severe epistaxis is likely to increase in frequency significantly over the next two decades. Sphenopalatine artery embolization is rapidly becoming the most common type of procedural intervention. The efficacy of endovascular embolization is dependent on a refined understanding of the anatomy and collateral physiology of this circulation as well as the impact of temporizing measures such as nasal packing and inflation of a nasal balloon. Likewise, safety is dependent on a detailed appreciation of collateralization with the internal carotid artery and ophthalmic artery. Cone beam CT imaging has the resolution to enable a clear visualization of the anatomy and collateral circulation associated with the arterial supply to the nasal cavity, in addition to assisting with hemorrhage localization. We present a review of epistaxis treatment, a detailed description of anatomic and physiologic considerations informed by cone beam CT imaging, and a proposed protocol for sphenopalatine embolization for which there is currently no standard.

The estimation of demographic parameters is a key component of evolutionary demography and conservation biology. Capture-mark-recapture methods have served as a fundamental tool for estimating demographic parameters. The accurate estimation of demographic parameters in capture-mark-recapture studies depends on accurate modeling of the observation process. Classic capture-mark-recapture models typically model the observation process as a Bernoulli or categorical trial with some detection probability conditional on a marked individual’s availability for detection (e.g., alive, or alive and present in a study area). Alternatives to this approach are underused, but may have great utility in capture-recapture studies. In this paper we explore a simple concept: in the same way that counts contain more information about abundance than simple detection/non-detection data, the number of encounters of individuals during observation occasions contain more information about the observation process than detection/non-detection data for individuals during the same occasion. Rather than using Bernoulli or categorical distributions to estimate detection probability, we demonstrate the application of zero-inflated Poisson and gamma-Poisson distributions. This allows for inference on availability for encounter (i.e., temporary emigration), as well as a wide variety of parameterizations for heterogeneity in the observation process. We demonstrate that this approach can accurately recover demographic and observation parameters in the presence of individual heterogeneity in detection probability, and discuss some potential future extensions of this method.

Cryopreservation was recommended to ensure continuity in allogeneic hematopoietic progenitor cells (HPC) transplantation during the COVID-19 pandemic. Several groups have shown no impact on clinical outcomes for patients who underwent HPC transplantation with cryopreserved products during the first months of this pandemic. However, concerns about quality control attributes after cryopreservation have been raised. We investigated, in 155 allogeneic peripheral blood cryopreserved HPC, leukocytapheresis characteristics influencing viable CD34(+) and CD3(+) cells, and CFU-GM recoveries after thawing. Collection characteristics such as volume, nucleated cells (NC)/mL and hematocrit correlated with viable CD34(+) and CD3(+) cells recoveries after thawing in univariate analysis but only CD3(+) cells remained statistically significant in multivariate analysis (r2 = 0.376; P = < 0.001). Additionally, transit time also showed correlation with viable CD34(+) (r2 = 0.186), CD3(+) (r2 = 0.376) and CFU-GM recoveries (r2 = 0.212) in multivariate analysis. Thus, diluting leukocytapheresis below 200 × 10(6) NC/mL, avoiding red cells contamination above 2%, cryopreserving below 250 × 10(6) NC/mL and minimizing transit time below 36 h, prevented poor viable CD34(+) and CD3(+) cells, and CFU-GM recoveries. In summary, optimizing leukocytapheresis practices and minimizing transportation time may better preserve the quality attributes of HPC when cryopreservation is indicated.

Plant-pollinator interactions are partially driven by the expression of plant traits that signal and attract bees to the nutritional resources within flowers. Although multiple physical and chemical floral traits are known to influence the visitation patterns of bees, how distinct bee groups vary in their responses to floral traits has yet to be elucidated. In this study, we used a common garden experiment to test for morphological floral traits associated with pollen quantity at the plant species level, and examined how the visitation patterns of taxonomically and functionally distinct bee groups are related to flower trait characteristics of 39 wildflower species. We also determined how floral traits influence the structure of wild bee communities visiting plants and whether this varies among geographic localities. Our results suggest that floral area is the primary morphological floral trait related to bee visitation of several distinct bee groups, but that wild bee families and functionally distinct bee groups have unique responses to floral trait expression. The composition of the wild bee communities visiting different plants was most strongly associated with variability in floral area, flower height, and the quantity of pollen retained in flowers. Our results inform wildflower habitat management for bees by demonstrating that the visitation patterns of distinct bee taxa can be predicted by floral traits, and highlight that variability in these traits should be considered when selecting plants to support pollinators.

The northernmost part of the Cache Creek terrane lies in south-central Yukon and comprises metavolcanic rocks, hemipelagic chert and shale, newly identified volcaniclastic and clastic rocks (Michie formation, informal), pyroxenite and gabbro intrusive rocks with an arc to back-arc geochemical signature, as well as tectonized and serpentinized ultramafic rocks. The proximally sourced Michie formation yielded zircon from two samples with unimodal peaks at 245.85 ± 0.07 and 244.64 ± 0.08 Ma. These dates are likely close to the depositional ages and compare favourably with those from the Kutcho assemblage of northern British Columbia. The Michie formation is exposed along the northwestern flank of Mount Michie and represents singular detrital input from a nearby eroding island-arc. The Cache Creek terrane rocks are imbricated with epiclastic and carbonate rocks of the Stikinia and Lower Jurassic siliciclastic rocks of the synorogenic Whitehorse trough. This imbrication records two compressional deformation phases in the region: (1) an initial phase of west-verging thrusting along the Judas Mountain fault that placed the Cache Creek terrane rocks over the arc and basinal rocks of Stikinia and Whitehorse trough; and (2) a second phase of east-verging thrusting along the Mount Michie fault that repositioned rocks of Stikinia and the Whitehorse trough structurally above those of the Cache Creek terrane. Deformation in the centre of the study area was followed by emplacement of a coarse-grained syenite that yielded 40Ar/39Ar biotite and muscovite cooling ages of 165–160 Ma.

Background: Limited data are available on endovascular thrombectomy (EVT) efficacy and safety in large vessel occlusion (LVO) patients presenting >24hr from last known well (LKW). We compared outcomes between patients receiving EVT and best medical management (MM) in a multicenter international cohort. Methods: Consecutive patients with anterior circulation LVO presenting >24h after LKW from 13 centers from 7/2012-4/2021 were analyzed. Multivariable models for 90d mRS distribution and symptomatic ICH were adjusted for age, NIHSS, glucose, IV tPA, transfer status, clot location, time from LKW, CT ASPECTS and ischemic core (rCBF6s volumes. Results: Of 240 patients with a median (IQR) LKW to presentation 28.3h (24.9-38.2), 153 (64%) received EVT. Baseline characteristics were similar except for NIHSS (EVT: 13 (8-20) vs MM: 17 (10-22), p=0.005), CT ASPECTS (EVT: 8(6-9) vs MM: 4(3-6), p Conclusions: EVT may be associated with better functional outcomes, despite numerically increased risk of sICH in patients presenting with anterior circulation LVO beyond 24 hours. Further prospective studies are warranted.

Introduction: Acute ischemic stroke due to basilar artery occlusion (AIS-BAO) results in significant morbidity and mortality. Endovascular thrombectomy (ET) has not been shown to improve outcomes in AIS-BAO patients in randomized trials, which may be due to insufficient selection before ET. We determined whether the Critical Area Perfusion Score (CAPS) and posterior circulation ASPECTS (PC-ASPECTS) predict a favorable response to ET. Methods: We performed a multicenter retrospective study of AIS-BAO patients with perfusion imaging prior to ET. PC-ASPECTS was determined on NCCT by evaluating the cerebellum (1 point/hemisphere), pons (2 points), midbrain (2 points), thalamus (1 point/hemisphere), and posterior cerebral artery (1 point/hemisphere) territories, and points were subtracted for hypodensity in these regions. CAPS was quantified severe hypoperfusion (Tmax >10s) in cerebellum (1 point/hemisphere), pons (2 points), midbrain and/or thalamus (2 points). The primary outcome was a favorable outcome 90-days after ET (modified Rankin Scale [mRS] 0-3). Results: 89 patients were included. CAPS (AUC=0.70 [95% CI: 0.59-0.80]; p=0.002) and PC-ASPECTS (AUC=0.63 [95% CI: 0.52-0.75]; p=0.034) both predicted favorable outcomes in a receiver operating curve analysis, but there was no difference between the two (p=0.434). After dichotomization, patients with favorable CAPS (≤3) and PC-ASPECTS (≥7) were more likely to achieve a good functional outcome after successful reperfusion after ET (Figure). However, an unfavorable CAPS (>3) was associated with poor outcomes despite successful thrombectomy in all patients, whereas 22% of patients with unfavorable PC-ASPECTS ( Conclusions: CAPS and PC-ASPECTS both identify AIS-BAO patients who are likely to have a favorable clinical response to ET. CAPS, but not PC-ASPECTS, appears to accurately identify a subgroup in whom ET may be futile.

Introduction: Randomized trial evidence and data emerging from routine use support the non-inferiority on clinical outcomes of tenecteplase (TNK) compared to alteplase (ALT) for ischemic stroke thrombolysis. The lower cost of TNK is another potential advantage. We evaluated the hospital costs associated with either drug in a regional stroke network that switched to TNK. Methods: Our 10-hospital stroke network adopted TNK as local standard of care in September 2019. We previously reported clinical outcomes for TNK after 15 months (n=234) to the two prior years of ALT (n=354) using our regional REDCap stroke registry. The current analysis linked these registry patients to the hospital cost accounting system to compare cost categories between the two groups. Results: Table 1 shows the hospital costs overall and by hospital category. Total costs were greater for the ALT group: median (IQR) $15,841 (12,300, 22,323) for ALT vs $13,382 (10,686, 20,636) for TNK (p Discussion and Conclusion: In our regional hospital network after 15 months, TNK thrombolysis of stroke was associated with reduced overall costs, driven primarily by Pharmacy costs. An expanded analysis including other markets that switched to TNK in our national hospital system is in progress. If the current results generalize, the savings potential with a switch to TNK as the standard could be substantial for the health care system.

Introduction: Despite pharmacological and practical advantages for tenecteplase (TNK) over alteplase (ALT), no differences were observed in percent of symptomatic intracranial hemorrhage (sICH) in randomized trials (fewer than 900 total patients for either treatment). We compared rates of sICH in patients treated with either drug, using a large, multicenter, international registry. Methods: The CERTAIN collaboration is an ongoing registry of deidentified patient-level data of thrombolytic treated ischemic stroke from various hospitals/programs in New Zealand, Australia, and the United States that have used ALT or TNK since July 1, 2018. Standardized data were abstracted and harmonized from local or regional clinical registries. We defined sICH as clinical worsening of at least 4 points on NIHSS, attributed to parenchymal hematoma, subarachnoid or intraventricular hemorrhage. We used logistic regression for binary variables, adjusting sICH differences for age, baseline NIHSS, thrombectomy, and source hospital network and Mann-Whitney test for continuous baseline variables. Results: A total of 7891 patients were included in the initial analysis. The TNK group was older, more likely to be male, had higher NIHSS, and more frequently underwent mechanical thrombectomy (Table. Sample Characteristics). The sICH rate was 3.71% for ALT and 2.13% for TNK: adjusted OR (95%CI) = 0.49 (0.31-0.76) p=0.002. For patients not undergoing thrombectomy after thrombolytic, the sICH rate was 3.00% for ALT and 1.74% for TNK, adjusted OR (95%CI) = 0.48 (0.27-0.87), p=0.016. For thrombectomy treated cases, sICH rate was 6.80% for ALT and 2.80% for TNK, adjusted OR (95%CI) 0.60 (0.31-1.16), p=0.129. Conclusion: In this preliminary analysis from a large, multicenter registry, ischemic stroke treated with tenecteplase was associated with a lower rate of sICH than with alteplase. An updated analysis with patient data from additional sites will be presented at the Conference.

In this study, the authors sought to assess whether cord blood units (CBUs) collected from donors of non-European ethnic backgrounds are utilized for umbilical cord blood transplantation (UCBT) at a different rate than those of European ethnic backgrounds. The authors also examined potential methods of enriching these under-represented ethnic backgrounds in cord blood bank (CBB) inventories without increasing financial overheads and without compromising total inventory utilization or post-transplant outcomes.Data from N = 6506 searchable or shipped Anthony Nolan Cell Therapy Centre grafts were used in this study. Banked grafts were graded from A+ to D based on total nucleated cell and CD34+ cell content. Utilizations of each grade group were further stratified by graft ethnic background. The Mantel-Cox log-rank test was performed in conjunction with Kaplan-Meier survival analysis to compare utilization rates and post-transplant outcomes. For shipped grafts, levels of HLA matching at HLA-A, HLA-B and HLA-DR loci were also analyzed by graft ethnic background and grade using data from the Eurocord/EBMT registry.Overall utilization of non-European grafts did not significantly differ from that of European grafts (2.5% versus 2.2%, P = 0.23). However, significant differences were found when stratifying utilization rates by cell content. The probability of non-European D grade grafts being utilized was 3-fold higher than that of European D grade grafts (1.1% versus 0.4%, P = 0.03) and comparable to that of European C grade grafts (1.1% versus 0.9%, P = 0.90). No significant differences were found between D and C grade grafts in terms of overall survival (OS) (P = 0.12), in part due to a disproportionate utilization of D grade grafts for pediatric UCBT (74% versus 39%, age difference P0.001). Furthermore, non-European graft shipments were 4-fold less likely to be a 6/6 HLA match to their recipients relative to European graft shipments (7% versus 29%).The authors have identified a niche for CBUs of low cell content collected from donors of non-European ethnic backgrounds that has been overlooked by previous studies. Banking of these CBUs for pediatric UCBT instead of CBUs from European donors containing modestly higher cell content is an ethical approach to increasing the ethnic diversity of CBB inventory-and, consequently, the probability of non-European recipients finding a 6/6 HLA-matched graft-without compromising post-transplant OS or overall rate of inventory utilization.

ImportanceThe role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well.ObjectiveTo evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well.Design, Setting, and ParticipantsThis retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand. Eligible patients had occlusions in the internal carotid artery or middle cerebral artery (M1 or M2 segment) and were treated with EVT or medical management beyond 24 hours of last known well.InterventionsEndovascular thrombectomy or medical management (control).Main Outcomes and MeasuresPrimary outcome was functional independence (modified Rankin Scale score 0-2). Mortality and symptomatic intracranial hemorrhage (sICH) were safety outcomes. Propensity score (PS)–weighted multivariable logistic regression analyses were adjusted for prespecified clinical characteristics, perfusion parameters, and/or Alberta Stroke Program Early CT Score (ASPECTS) and were repeated in subsequent 1:1 PS-matched cohorts.ResultsOf 301 patients (median [IQR] age, 69 years [59-81]; 149 female), 185 patients (61%) received EVT and 116 (39%) received medical management. In adjusted analyses, EVT was associated with better functional independence (38% vs control, 10%; inverse probability treatment weighting adjusted odds ratio [IPTW aOR], 4.56; 95% CI, 2.28-9.09; P P = .003). This association persisted after PS-based matching on (1) clinical characteristics and ASPECTS (EVT, 35%, vs control, 19%; aOR, 3.14; 95% CI, 1.02-9.72; P = .047); (2) clinical characteristics and perfusion parameters (EVT, 35%, vs control, 17%; aOR, 4.17; 95% CI, 1.15-15.17; P = .03); and (3) clinical characteristics, ASPECTS, and perfusion parameters (EVT, 45%, vs control, 21%; aOR, 4.39; 95% CI, 1.04-18.53; P = .04). Patients receiving EVT had lower odds of mortality (26%) compared with those in the control group (41%; IPTW aOR, 0.49; 95% CI, 0.27-0.89; P = .02).Conclusions and RelevanceIn this study of treatment beyond 24 hours of last known well, EVT was associated with higher odds of functional independence compared with medical management, with consistent results obtained in PS-matched subpopulations and patients with presence of mismatch, despite increased odds of sICH. Our findings support EVT feasibility in selected patients beyond 24 hours. Prospective studies are warranted for confirmation.

The Migratory Bird Treaty Act (MBTA) is critical to avian conservation in the United States, both through its protection of migratory birds and as a catalyst for a century of coordinated avian conservation. While more than 1,000 species are protected by MBTA, of extant bird species native to the continental U.S., only 20 species belonging to the order Galliformes are explicitly excluded. Management of galliforms has occurred largely without direct federal oversight, placing this group on a fundamentally different conservation path during the century following MBTA passage. In this paper, we review the historical context and biological justification for exclusion of galliforms from MBTA and synthesize how their present-day conservation differs from that of migratory birds. We find the most prominent difference between the two groups involves the scope of coordination among stakeholders. The U.S. government, primarily via the Department of Interior, acts as de facto coordinating body for migratory bird conservation and plays the central role in oversight, funding, and administration of management in the United States. In contrast, galliform management falls primarily to individual state wildlife agencies, and coordinated conservation efforts have been more ad hoc and unevenly spread across species. Migratory birds benefit from an almost universally greater scope of research and monitoring, scale of habitat conservation, and sophistication of harvest management compared with galliforms. Galliform harvest management plans, in particular, are less likely to use measurable objectives, reporting of uncertainty in population parameters, and explanation of harvest management techniques. Based on a review of species status lists (e.g., the U.S. Endangered Species Act), we found no evidence that galliforms were more frequently listed than migratory species. Regional trend estimates from the North American Breeding Bird Survey (BBS) were more likely to be negative for galliforms over the period 1966–2015, but this was primarily driven by Northern Bobwhite (Colinus virginianus). Data to assess galliform population status are generally poor, which complicates assessment for roughly half of galliform species. Increased support for coordination among state agencies and other stakeholders, similar to that applied to migratory birds, could help to ensure that galliform conservation is poised to tackle forthcoming challenges associated with global change.

BackgroundCerebral aneurysm rupture is associated with high rates of morbidity and mortality. Detecting aneurysms at high risk of rupture is critical in management decision making. Rupture risk has traditionally been associated with size—measured as a maximum dimension. However, aneurysms are morphologically dynamic, a characteristic ignored by large prospective aneurysm risk studies. Manual measurement is challenging and fraught with error. We used an artificial intelligence (AI) measurement tool to study aneurysms that ruptured during conservative management to detect changes in size not appreciated by manual linear measurement.MethodsA single practice database with >5000 aneurysms was queried. Patients followed conservatively for an unruptured aneurysm were identified using appropriate diagnosis codes. This cohort was screened for subsequent rupture using procedure codes. Only patients with two vascular imaging studies before rupture were included.ResultsFive patients met the criteria. All patients had aneurysm enlargement, two of which were not detected from manual linear measurements, including adjudication and analysis, during a multidisciplinary neurovascular conference in a high volume practice. Maximum dimension increased at a minimum of 1.8% (range 1.8–63.3%) from the first scan to the last, and aneurysm volume increased at a minimum of 5.9% (5.9–385.5%), highlighting the importance of volumetric measurement.ConclusionsAI-enabled volumetric measurements are more sensitive to changes in size and detected enlargement in all aneurysms that ruptured during conservative management. This finding has major implications for clinical practice and methods used for interval aneurysm measurement in patients being conservatively followed.

Background and Purpose Previous studies on racial disparity in mechanical thrombectomy (MT) treatment of acute large vessel occlusion (LVO) stroke lacked individual patient data that influences treatment decision-making. We assessed patient-level data in a large United States healthcare system from 2016-2020 for racial disparities in MT utilization and eligibility. Methods The following variables were extracted for all stroke patients presenting to 42 hospitals in 12 states between January 1, 2016-September 30, 2020: age, gender, race, median income and population density of residential zip code, stroke certification of presenting hospital, baseline ambulatory status, and NIH stroke scale. Multivariate logistic regression was used to analyze associations between each characteristic and the following dependent variables: (1) overall rate of treatment with MT; (2) proportion of patients arriving to the hospital within 5 hours of last known well (‘early arrival’); (3) proportion of early arrival patients with documented anterior circulation LVO (aLVO; ICA terminus, M1 or M2 occlusion); (4) rate of MT among early-arrival patients with documented aLVO. Results The cohort included 34,596 patients: 26,640 White, non-Hispanic (‘White’; 77.0%) and 7,956 African American or Black (‘Black’; 23.0%). Black patients were less likely to undergo MT (aOR, 0.72; 95% CI 0.61-0.84; table 1), arrive within 5 hours of LKW (aOR, 0.73; 95% CI 0.68-0.78; table 2) and have documented aLVO (aOR, 0.70; 95% CI 0.58-0.84; table 3). Race was not associated MT among early arrival patients with documented aLVO (table 4). Conclusions Black stroke patients underwent MT less frequently than Whites, likely in part due to longer times from LKW to hospital arrival and a lower rate of documented aLVO. Further studies are needed to assess whether extending the MT time window and more aggressive LVO screening protocols mitigate this disparity. Disclosures A. Wallace: None. D. Gibson: 2; C; iSchemaView, Medtronic, Siemens. K. Asif: None. D. Sahlein: 2; C; Medtronic, Microvention, Stryker, Phenox. 3; C; Medtronic. S. Warach: None. T. Malisch: None. M. Lamonte: None.

Habitat selection and its relationship to fitness is a fundamental concept in ecology, but the mechanisms driving this connection are complex and difficult to detect. Despite the difficulties in understanding such intricate relationships, it is imperative that we study habitat selection and its relationship with fitness. We compared habitat selection of least terns (Sternula antillarum) and piping plovers (Charadrius melodus) on the Missouri River (2012–2014) to examine the consequences of those choices on nest and chick survival. We hypothesized that plovers and terns would select habitat that minimized the chance of flooding and predation of eggs, chicks, and adults, but that plovers would also select habitat that would provide foraging habitat for their chicks. We developed an integrated habitat selection model that assessed selection across multiple scales (sandbar and nest scales) and directly modeled the effect of selection on nest and chick survival. In general, the species selected habitat in keeping with our hypotheses, such that predation and flooding, in particular, may have been reduced. Sandbar selection had either a negative or no appreciable effect on nest survival for both species across years. Nest‐site selection in 2012 had a generally positive effect on nest survival and chick survival for both terns and plovers, and this trended toward a negative effect by 2014. This result suggested that early selection decisions appeared to be adaptive, but we speculate that relatively high site fidelity and habitat degradation led to reduced benefit over time. Our results highlight the complex nature of habitat selection and its relationship to fitness., While the connection between species and their habitats is broadly accepted, the connections between habitat and overall fitness often are less well understood. We compared habitat selection of piping plovers and least terns on the Missouri River (2012–2014) to examine the consequences of those choices on nest and chick survival. Our results suggest that early selection decisions were adaptive, but that relatively high site fidelity and habitat degradation led to reduced benefit over time.

The estimation of abundance is fundamental to ecology and conservation but often is difficult or impossible to accomplish reliably. Recent improvements in wildlife cameras and ecological modelling have allowed for improved accuracy in estimates of abundance. In this study, we paired nest captures and high‐definition nest video camera monitoring with modelling for a novel approach to estimate survival and abundance of threatened Piping Plovers Charadrius melodus breeding on Missouri River sandbars. From 2005 to 2014, we captured individuals on nests and uniquely marked them and recaptured previously marked individuals. In 2015–2017, we resighted marked individuals using small, high‐definition video cameras deployed at nests, and counted the number of marked and unmarked breeding individuals associated with nests. We estimated apparent survival and derived estimates of the abundance of breeding individuals and population growth each year using a state‐space Jolly–Seber superpopulation model with the addition of a binomial band ratio model for data collected using nest video cameras. Apparent survival averaged 0.73 ± 0.03 (mean ± sd) throughout the study. The number of breeding individuals varied, with the population increasing from 2012 to 2017 following a major habitat creation event. This study provides one of the few examples of camera data being used to produce demographic parameter and abundance estimates for an avian species. The camera and modelling methods described in this study may be applicable to other avian species in which some portion of the breeding population is uniquely marked.

A possible Mesozoic-Cenozoic trajectory for the North American craton is outlined from latitude changes of the craton derived from a revised apparent polar wander path, and from westward movement of the craton based on the assumption that Africa has been the least mobile continent geographically since the latest Paleozoic. During each of five time intervals that span 220 million years, the craton trajectory had a different vector. Each vector appears to be reflected in the Canadian Cordillera by the dominant style and orientation of structures formed during that interval. For much of the past ~ 220 million years, the ~meridionally-oriented western margin of the Pangea-Laurasia-North America Plate has been the site of arc magmatism where weak arc/back arc lithosphere, sandwiched between strong ocean-floor and craton lithospheres at times coupled across convergent or transform plate boundaries, focused and recorded strain. When the craton apparently moved due westward, between ~180–160 Ma and ~120–60 Ma, the dominant structures formed then record orogen-normal compression and were accompanied by orogeny. Structures formed during the earlier episode are mainly in the eastern and interior Cordillera and their formation shortly followed or coincided with accretion of most terranes to the craton margin. In the later episode, compressional structures span the entire Cordillera, which emerged as a tectonic and physiographic entity. Before and between these intervals, when the craton apparently moved mostly northwestward, mainly geological and paleomagnetic considerations indicate some terranes moved southward (sinistrally) relative to the craton. After ~60 Ma, southwestward movement of the craton was concurrent with large northward (dextral) strike-slip faults that disrupted the newly-established ancestral Cordillera. The coincidence between the age of structures that record dominant orogen-normal compression at times when the craton apparently moved due westward, and orogen-parallel displacements when the craton had either northward or southward components of motion, suggests the craton, acting as a “Continental Bulldozer”, was the primary driver of Cordilleran deformation and orogenesis.

Background: Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO) patients with mild deficits is unclear. Methods: Pooled cohort of pts with mild deficits (NIHSS Results: Of 371 pts, 189 (51%) had EVT. Time LKW to EVT center: EVT 165 (70- 416) vs MM 200 (72-564) min, p=0.35 were similar. EVT pts had larger perfusion lesions (51 cc (23-86) vs 30.1 (5, 65), p0.99, neuro-worsening 17% vs 6%, p=0.30) and mortality 5% vs 3%, p>0.99). Without target profile, excellent outcomes were similar without a shift, Fig 1C. Safety was worse with EVT: sICH 8% vs 0%, p=0.001; neuro-worsening 20% vs 3%, p Conclusion: EVT was not associated with improved outcomes in patients with mild deficits; safety was worse. However, EVT was safe and associated with improved outcomes in target profile patients.

Umbilical Cord Blood (UCB) is an alternative source of hematopoietic stem cells for transplantation. A UCB bank is a multidisciplinary structure that is responsible for the recruitment, collection, processing, testing, cryopreservation, storage, listing, reservation, release, and distribution of units for administration. Also, UCB can be transferred for life-saving research. Before labor, adequate information and consent, including possibility of repurposing donation shall be performed. After delivery and using appropriate techniques placental blood can be collected and processed for therapeutic purposes. Cell processing normally consists of volume reduction to achieve a reasonable reduce of storage area. Automatic procedures have some advantages on reproducibility. A banking project starts with an establishment phase where banks should have a rapid growth to achieve their operational size. Then a maintenance phase follows, once the optimum inventory is achieved where UCB banks should focus in increasing quality and diversity. As consequence a decrease in numbers of newly added units are expected. The fact that less than 20% of collected units have more than 150x107 total nucleated cells, estimated to be the threshold for efficient inventories, challenge ethics of donation programs. Therefore, UCB banks need to research on alternative uses to add value to the surplus units and the available inventory. Finally, integration with other cell therapy services will reduce fix costs of operation and contribute sustainability.

Highlights 5• Analysis of 7,389 patients from 11 states presenting before and after onset of COVID-19 pandemic 5• Stroke, IV tPA, and thrombectomy volumes decreased 35.0%, 33.4%, and 8.9% during early pandemic 5• Stroke patients during pandemic had higher baseline function and higher NIHSS on presentation 5• Stroke process measures and outcomes during early pandemic did not differ from pre-pandemic period, Background and Purpose Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic. Methods Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals from January 1-June 30, 2020 were analyzed with piecewise linear regression and linear spline models. Univariate analysis compared pandemic (case) and control groups defined in relation to the nadir of daily strokes during the study period. Significantly different patient characteristics were further evaluated with logistic regression, and significantly different process measures and outcomes were re-analyzed after propensity score matching. Results Analysis of 7,389 patients found daily stroke volumes decreased 0.91/day from March 12-26 (P < 0.0001), reaching a nadir 35.0% less than expected, and increased 0.15 strokes/day from March 27 – June 23, 2020 (P < 0.0001). Thrombolytic administrations decreased 3.3/week from February 19-March 31 (P=0.0023), reaching a nadir 33.4% less than then expected, and increased 1.4 administrations/week from April 1-June 23 (P

This study presents a re-examination of historical specimens (DG136 and DG167) from the Monashee complex in the southeastern Canadian Cordillera that are critical to the current understanding of rare earth element (REE) distribution between garnet and monazite (and other accessory minerals) during metamorphism. Nine-hundred and fifty-one new monazite petrochronology spot analyses on 29 different grains across two specimens outline detailed (re)crystallization histories. Trace element data collected from the same ablated volume, interpreted in the context of new phase equilibria modelling that includes monazite, xenotime and apatite, link ages to specific portions of the pressure–temperature (P-T) paths followed by the specimens. These linkages are further informed by garnet Lu-Hf geochronology and xenotime petrochronology. The clockwise P-T paths indicate prograde metamorphism was ongoing by ca. 80 Ma in both specimens. The structurally deeper specimen, DG136, records peak P-T conditions of ~755–770 ℃ and 8.8–10.4 kbar, interpreted to coincide with (re-)crystallization of low Y monazite at ∼75–70 Ma. Near-rim garnet isopleths from DG167 cross in the observed peak assemblage field at ∼680 °C and 9.3 kbar. These conditions are interpreted to correspond with low Y monazite (re-)crystallisation at ∼65 Ma. Both specimens record decompression along their retrograde path coincident with high Y 70–55 Ma and 65–55 Ma monazite populations in DG136 and DG167, respectively. These findings broadly agree with those initially reported ∼20 years ago and confirm early interpretations using trace elements in monazite as generally reliable markers of metamorphic reactions. Modern phase equilibria modelling and in situ petrochronological analysis, however, provide additional insight into monazite behaviour during anatexis and the effects of potential trace element buffering by REE-bearing phases such as apatite.