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Colin R. Alexander, ed., The Frontiers of Public Diplomacy: Hegemony, Morality and Power in the International Sphere. Routledge, 2021, pp. 238, £120, ISBN 9780367343460.

Background: Neuroinflammation is ubiquitous in acute stroke and worsens outcome. However, the precise timing of the inflammatory response is unknown, hindering the design of acute anti-inflammatory therapeutic interventions. We sought to identify the onset of the neuroinflammatory cascade using a mobile stroke unit. Methods: The study is a proof-of-concept, cohort investigation of ultra-early blood- and extracellular vesicle–derived markers of neuroinflammation and outcome in acute stroke. Blood was obtained, prehospital, on an mobile stroke unit. Outcomes were biomarker concentrations, modified Rankin Scale score, and National Institutes of Health Stroke Scale score. Results: Forty-one adults were analyzed, including 15 patients treated on the mobile stroke unit between August 2021 and April 2022, and 26 healthy controls to establish biomarker reference levels. Median patient age was 74 (range, 36–97) years, 60% were female, and 80% White. Ten (67%) were diagnosed as stroke, with 8 (53%) confirmed and 2 likely transient ischemic attack or stroke averted by thrombolysis; 5 were stroke mimics. For strokes, median initial National Institutes of Health Stroke Scale score was 11 (range, 4–19) and 6 (75%) received tPA (tissue-type plasminogen activator). Blood was obtained a median of 58 (range, 36–133) minutes after symptom onset. Within 36 minutes after stroke, plasma IL-6 (interleukin-6), neurofilament light chain, UCH-L1 (ubiquitin C-terminal hydrolase L1), and GFAP (glial fibrillary acidic protein) were elevated by as much as 10 times normal. In EVs, MMP-9 (matrix metalloproteinase-9), CXCL4 (chemokine (C-X-C motif) ligand 4), CRP (C-reactive protein), IL-6, OPN (osteopontin), and PECAM1 (platelet and endothelial cell adhesion molecule 1) were elevated. Inflammatory markers increased rapidly in the first 2 hours and continued rising for 24 hours. Conclusions: The neuroinflammatory cascade was found to be activated within 36 to 133 minutes after stroke and progresses rapidly. This is earlier than observed previously in humans and suggests injury from neuroinflammation occurs faster than had been surmised. These findings could inform development of acute immunomodulatory stroke therapies and lead to new diagnostic tools and improved outcomes.

Background: Neuroinflammation is ubiquitous in acute stroke and worsens outcome. However, the precise timing of the inflammatory response is unknown, hindering the design of acute anti-inflammatory therapeutic interventions. We used a mobile stroke unit (MSU) to identify the onset of the neuroinflammatory cascade within minutes of symptom onset. Methods: The study is a prospective, cohort investigation of ultra-early blood- and extracellular vesicle (EV)-derived markers of neuroinflammation and outcome in acute stroke. Blood was obtained on the MSU with head CT, and from healthy controls. Plasma biomarkers were analyzed with ELISA, SIMOA and ECL. EVs were isolated with HSP pull down. Confirmed strokes, mimics and healthy controls were compared. Variables included demographics, mRS, NIHSS and discharge disposition. Results: Forty one adults were analyzed, including 15 patients treated on the MSU between August 2021 and April 2022, and 26 controls. For MSU patients, median age was 74 (range 36-97) years, 60% were female, and 80% white. Ten (67%) were diagnosed as stroke, with 8 (53%) confirmed and 2 likely TIA or stroke averted by thrombolysis; 5 were stroke mimics. For strokes, median initial NIHSS score was 11 (range 4-19) and 6 (75%) received tPA. Blood was obtained a median of 58 (range 36-133) minutes after symptom onset. Within 36 minutes after stroke, plasma interleukin-6 (IL-6), neurofilament light chain (NfL), ubiquitin C-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were elevated by as much as 10 times normal. In EVs, matrix metalloproteinase-9 (MMP-9), chemokine (C-X-C motif) ligand 4 (CXCL4), C-reactive protein (CRP), IL-6, osteopontin (OPN) and platelet and endothelial cell adhesion molecule 1 (PECAM1) were elevated. Inflammatory markers increased rapidly in the first two hours, and continued rising for 24 hours. Conclusions: This study found the inflammatory cascade is activated as early as 36 minutes after stroke, and progresses rapidly. This is earlier than observed previously in humans, and suggests injury from neuroinflammation may occur faster than had been surmised. The findings may inform development of immunomodulatory therapies for acute stroke, and lead to new diagnostic tools and improved outcomes.

Background: Few data exists on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. Methods: A pre-specified subgroup analysis of tPA-eligible patients with PD enrolled in a prospective multicenter trial of Mobile Stroke Units (MSUs) vs standard management by emergency medical services (EMS). All patients had baseline mRS scores. Co-primary outcomes were mean utility-weighted modified Rankin Scale score (uw-mRS) and return to baseline mRS at 90 days. Linear and logistic regression models compared outcomes in patients with vs without PD, and patients with PD treated by MSU vs EMS. Time metrics, safety, quality of life, and health-care utilization were also compared. Results: Of 1047 patients, 254 had baseline mRS >= 2 (159 MSU, 95 EMS; 31% mRS 2, 52% mRS 3, 17% mRS 4). Compared to patients without disability, patients with PD were older, had higher NIHSS, more comorbidities, less often lived at home, were treated slower, and had less thrombectomy. Patients with PD had worse 90-day uw-mRS (0.39 vs 0.80), higher mortality, more health-care utilization and worse quality of life than patients without PD. However, rates of symptomatic intracranial hemorrhage and final diagnoses of stroke mimics were similar between groups, and 52% of patients with PD returned to their baseline mRS. Patients with PD treated within the first hour had better 90-day uw-mRS than those treated later (0.48 vs 0.36, p=0.01). Comparing patients with PD treated by MSU vs EMS, time from last-known-well to tPA bolus was shorter (82 vs 111 min), and 24% vs 0% were treated in the first hour. Among patients with PD, MSU patients had non-significantly better 90-day uw-mRS (0.41 vs 0.35, p=0.09) and higher rate of returning to baseline mRS (56% vs 44%, p=0.09) than EMS patients. There was no interaction between either time to treatment (p=0.24) or MSU vs EMS group assignment (p= 0.42), 90-day uw-mRS, and PD vs no disability status. Conclusion: Although outcomes after stroke are less favorable in patients with vs without PD, in a large, controlled trial, we found no interaction between baseline disability and the benefit of MSU treatment. Our data support the earliest treatment of acute stroke patients regardless of premorbid functional status.

Background Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard m...

COVID-19 was initially described as a pulmonary disease. Increasing attention is now directed to extrapulmonary disease manifestations mediated by viral tropism to the vascular endothelium. Here, we report a case of an adult patient with COVID-19 who presented to the emergency department with neurological signs disproportionate to pulmonary symptoms and was found to have a subacute ischemic stroke. Imaging studies suggested an active inflammatory vasculopathy. The case highlights the utility of vascular wall imaging studies when positive findings are present on emergent CT angiography. Current treatment algorithms should consider the addition of adjunct intracranial vessel wall imaging to assess for inflammatory vasculopathy when a patient with acute or recent COVID infection presents to the emergency department with stroke.

International tertiary student mobility will continue to rise as governments and universities support diversity in education and prioritize international experience. With this mind, it should be a priority to study the impacts and impediments of student adjustment in their chosen countries. The authors advance a line of inquiry, which seeks to explore personal experiences of four distinct groups of tertiary students and identify the positives, and in particular the negative aspects of their study abroad experience. The central argument which heretofore has been understudied is that student ethnicity and incompatibility of ethnic group identities and their expressions mark the central feature inhibiting student adjustment within the Thai context.

Background: Stroke alert systems provide rapid evaluation of suspected strokes to aid timely thrombolysis and mechanical thrombectomy. Given consequences of delayed or missed diagnosis, these systems are intentionally more sensitive than specific for confirmed stroke. However, substantial physician and hospital resources are involved. We sought to evaluate characteristics and predictors of stroke mimics and confirmed strokes in a large stroke alert program. Methods: The study is a retrospective investigation of the stroke alert system at the University of Colorado Hospital. Variables included patient, clinical, stroke and stroke alert characteristics, and outcome. Variables were compared for patients with confirmed stroke, and mimics. Results: Stroke alerts were evaluated in 125 patients over a one-month period in 2019. Median age was 60 years (IQR 47-72), 52% were female, 51% were white, and 24% black or African American. Median initial NIHSS score was 4 (IQR 1-11), and onset was outside the hospital in 70%. One third of stroke alerts were confirmed stroke or TIA, and 66% were mimics. Most stroke alerts were called by the departments of Emergency Medicine (78%), Medicine (10%) and Surgery (9%). The most common of more than 40 stroke alert symptoms and combinations were weakness (45%), aphasia (20%), altered mental status (16%) and facial droop or numbness (each 14%). Stroke mimics were more likely to be female (58% female vs. 41% male, OR 2.206, 95% CI 1.025-4.745, p=0.041), had better initial NIHSS scores [3 (IQR 1-9) mimics vs. 6 (IQR 2-15) stroke, p=0.015), and were more often discharged to home (77% mimics vs. 51% strokes, OR 2.051, 95% CI 1.269-3.316, p=0.004). Stroke onset location and service initiating stroke alert were not associated with confirmed stroke. Weakness was the only symptom associated with confirmed stroke (58% stroke vs. 37% mimics, OR 2.447, 95% CI 1.137-5.268, p=0.021). Conclusions: Of stroke alerts in our institution, two thirds were stroke mimics, and these were more likely to be female patients. Weakness as a stroke alert symptom, alone or with other symptoms, was associated with confirmed stroke. Additional study is warranted to improve specificity and optimize utilization of physician and hospital resources in stroke alert programs.

Most clinical research stopped during COVID due to possible impact on data quality and personnel safety. We aimed to assess the impact of COVID on acute stroke clinical trial conduct at sites that continued to enroll patients during the pandemic. BEST-MSU is an ongoing study of Mobile Stroke Units (MSU) vs standard management of tPA-eligible acute stroke patients in the pre-hospital setting. MSU personnel include a vascular neurologist via telemedicine, and a nurse, CT technologist, paramedics and emergency medicine technicians on-board. During COVID, consent, 90-day modified Rankin Scale (mRS) and EQ5D were obtained by phone instead of in-person, but other aspects of management were similar to the pre-COVID period. We compared patient demographics, study metrics, and infection of study personnel during intra- vs pre-COVID eras. Five of 6 BEST-MSU sites continued to enroll during COVID. There were no differences in intra- (n = 57) vs pre- (n = 869) COVID enrolled tPA eligible patients’ age, sex, race (38.6% vs 38.0% Black), ethnicity (15.8% vs 18.6% Hispanic), or NIHSS (median 11 vs 9). The percent of screened patients enrolled and adjudicated tPA eligible declined from 13.6% to 6.6% (p < .001); study enrollment correlated with local stay-at-home and reopening orders. There were no differences in alert to MSU arrival or arrival to tPA times, but MSU on-scene time was 5 min longer (p = .01). There were no differences in ED door to CT, tPA treatment or thrombectomy puncture times, hospital length of stay, discharge disposition, or remote vs in-person 90-day mRS or EQ5D. One MSU nurse tested positive but did not require hospitalization. Clinical research in the pre-hospital setting can be carried out accurately and safely during a pandemic. tPA eligibility rates declined, but otherwise there were no differences in patient demographics, deterioration of study processes, or serious infection of study staff. Trial registration: NCT02190500

Reference genomes guide our interpretation of DNA sequence data. However, conventional linear references represent only one version of each locus, ignoring variation in the population. Poor representation of an individual's genome sequence impacts read mapping and introduces bias. Variation graphs are bidirected DNA sequence graphs that compactly represent genetic variation across a population, including large-scale structural variation such as inversions and duplications. Previous graph genome software implementations have been limited by scalability or topological constraints. Here we present vg, a toolkit of computational methods for creating, manipulating, and using these structures as references at the scale of the human genome. vg provides an efficient approach to mapping reads onto arbitrary variation graphs using generalized compressed suffix arrays, with improved accuracy over alignment to a linear reference, and effectively removing reference bias. These capabilities make using variation graphs as references for DNA sequencing practical at a gigabase scale, or at the topological complexity of de novo assemblies.

Purpose This paper aims to review past papers focused on understanding consumer-related topics in marketing and related interdisciplinary fields to demonstrate the applications of electroencephalogram (EEG) in consumer neuroscience. Design/methodology/approach In addition to the review of papers using EEG to study consumer cognitive processes, the authors also discuss relevant decisions and considerations in conducting event-related potential (ERP) studies. Further, a framework proposed by Plassmann et al. (2015) was used to discuss the applications of EEG in marketing research from papers reviewed. Findings This paper successfully used Plassmann et al.’s (2015) framework to discuss five applications of neuroscience to marketing research. A review of growing EEG studies in the field of marketing and other interdisciplinary fields reveals the advantages and potential of using EEG in combination with other methods. This calls for more research using such methods. Research limitations/implications A technical overview of ERP-related terminology provides researchers with a background for understanding and reviewing ERP studies. A discussion of method-related considerations and decisions provides marketing researchers with an introduction to the method and refers readers to relevant literature. Practical implications The marketing industry has been quick to adopt cutting edge technology, including EEG, to understand and predict consumer behavior for the purpose of improving marketing practices. This paper connects the academic and practitioner spheres by presenting past and potential EEG research that can be translatable to the marketing industry. Originality/value The authors review past literature on the use of EEG to study consumer-related topics in marketing and interdisciplinary fields, to demonstrate its advantages over-traditional methods in studying consumer-relevant behaviors. To foster increasing use of EEG in consumer neuroscience research, the authors further provide technical and marketing-specific considerations for both academic and market researchers. This paper is one of the first to review past EEG papers and provide methodological background insights for marketing researchers.

Deep learning is the trendiest tool in a computational biologist's toolbox. This exciting class of methods, based on artificial neural networks, quickly became popular due to its competitive performance in prediction problems. In pioneering early work, applying simple network architectures to abundant data already provided gains over traditional counterparts in functional genomics, image analysis, and medical diagnostics. Now, ideas for constructing and training networks and even off-the-shelf models have been adapted from the rapidly developing machine learning subfield to improve performance in a range of computational biology tasks. Here, we review some of these advances in the last 2 years.

Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

Motivation Genome-wide association studies (GWAS) are a powerful method to detect even weak associations between variants and phenotypes; however, many of the identified associated variants are in non-coding regions, and presumably influence gene expression regulation. Identifying potential drug targets, i.e. causal protein-coding genes, therefore, requires crossing the genetics results with functional data. Results We present a novel data integration pipeline that analyses GWAS results in the light of experimental epigenetic and cis-regulatory datasets, such as ChIP-Seq, Promoter-Capture Hi-C or eQTL, and presents them in a single report, which can be used for inferring likely causal genes. This pipeline was then fed into an interactive data resource. Availability and implementation The analysis code is available at www.github.com/Ensembl/postgap and the interactive data browser at postgwas.opentargets.io.

When a newcomer first enters Thailand they are often struck by the empirical duality of the country. From Bangkok’s shiny modern Suvarnabhumi Airport and well-kept motorway or train that brings a v...

Introduction: The impact of a Mobile stroke unit (MSU) on access to Endovascular Thrombectomy (ET) is a pre-specified BEST-MSU sub-study. On the MSU, ET decision-making steps such as CT, neurologic exam, and tPA treatment are completed prior to Emergency Room (ER) arrival. We hypothesized that such pre-ER assessment of potential ET patients on a MSU improves metrics. Methods: BEST-MSU is a prospective comparative effectiveness study of MSU vs Standard Management by Emergency Medical Services (SM). We compared ER door-to-puncture-time (mins, DTPT) among the following groups of MSU and SM patients: all ET patients (ETP), ET patients post-tPA (ETT), and ET patients post-tPA meeting thrombolytic adjudication criteria (ETTA) over the first four years of the study. Results: There were 161 ETP (67 SM, 94 MSU), 140 ETT (55 SM, 85 MSU), and 126 ETTA (50 SM, 76 MSU) patients. DTPT was shorter for MSU patients (ETP 89 vs 99, p=0.01; ETT 93 vs 100, p=0.03; ETTA 93 vs 99.5, p=0.03). From 2015 to 2018, DTPT decreased at a faster rate for SM compared with MSU-managed patients, improving by about an hour (Figure). Conclusion: Pre-ER ET evaluation on a MSU results in faster DTPT. Since 2015, dramatic improvement in ER ET metrics has attenuated this difference. However, DTPT of 90-100 mins in all groups indicates substantial room for improvement.

Background: The University of Colorado Mobile Stroke Unit (UC MSU) provides ambulance-mounted CT scanning and tele-stroke neurologic assessment in the Denver, CO, metropolitan area. As one of the first U.S. medical centers to utilize a mobile stroke protocol we sought to compare operational characteristics of the MSU during its first year with standard management (SM) of pre-hospital stroke alerts at a Comprehensive Stroke Center. Methods: The study compared patient and stroke characteristics, ambulance response, neurologic evaluation, and treatment between the MSU, and SM patients for the same ambulance service area. Variables included time from stroke alert (MSU or ambulance dispatch) to tPA administration, as well as time from arrival at the door of MSU or ED to first brain CT and to IV tPA administration. Patients were dichotomized into those with time from door to needle greater or less than the American Stroke Association “Target: Stroke” study goal of 45 minutes. Results: Between Jan. 15, 2016 and Jan. 9, 2017, 47 patients received prehospital management with the UC MSU, and 73 received standard management. Median age was 66 years (IQR 57-77), and 45% were female, with no difference between MSU and SM patients. Thirteen (28%) of patients were treated with IV tPA on the MSU, compared with 16 (22%) through SM. Median time was significantly shorter from door to first CT on the MSU than SM [4 minutes (IQR 4-5) MSU vs. 9 minutes (IQR 6-15) SM, p Conclusions: Patients treated via the MSU benefited from quicker time to CT, neurologic evaluation, and, critically, significantly shorter time from dispatch to tPA administration, compared with pre-hospital stroke alerts arriving from the same service area. These results suggest prehospital management with an MSU has potential to aid the goal of earlier thrombolysis after ischemic stroke symptom onset.

Background: University of Colorado Hospital, under the UCHealth system, developed a Mobile Stroke Unit (UCHealth MSU) which began clinical operation in January 2016 and added a second operational location in August 2016. As one of the first centers to institute ambulance-mounted brain imaging and neurologic evaluation and treatment in the field for acute stroke in the U.S., it was necessary to design unique, dynamic IT systems for operationalizing the MSU. These include high speed cellular, HIPAA-compliant cloud based environments and remote access to patient electronic medical records (EMR) and a reliable means for rapid image transfer. Here we describe novel technologies engineered and incorporated into the UCHealth MSU. Methods: Technological data-handling aspects of the UCHealth MSU were reviewed. Functions evaluated included wireless connectivity while in transit, EMR capability in the field, computed tomography (CT) scanning and image transfer, and communications for tele-stroke neurologic assessment. Results: The UCHealth MSU began clinical operation in January 2016, Wireless communications were designed with redundancy to avoid dropped signals during data transfer. Two IP destinations were assigned for videoconferencing and EMR data transfer, with split-tunnel architecture to direct traffic to each. Placement of the MSU antenna inside the unit reduced interference from home and business Wi-Fi routers encountered. Brain imaging acquired in the ambulance CT scanner is transferred initially to an onboard laptop, then via Citrix Receiver to a hospital-based server and can be visualized by the stroke neurologist, neuroradiologist and all other care providers. Picture Archiving Communications System (PACS) and Radiology Information System (RIS) are two of the XenApps used by CT technologists. Conclusions: Technological hurdles associated with remote imaging, assessment, and treatment, are critical to overcome if time-saving benefits of mobile stroke protocols are to be recognized. Innovative and unique techniques developed to accommodate wireless communication and image transfer from the field in the UCHealth MSU may aid start-up of similar units elsewhere and serve as a framework to further improve this technology.

Background: The University of Colorado Mobile Stroke Unit (UC MSU) began clinical operation in January 2016, providing ambulance-mounted CT scanning and tele-stroke neurologic assessment in the Denver, CO, metropolitan area. As one of the first U.S. tertiary stroke centers to utilize a mobile stroke protocol we sought to evaluate characteristics of response, neurologic evaluation, and treatment of the MSU. Methods: The study assessed patient, stroke, ambulance response, neurologic evaluation, and treatment characteristics of the UC MSU for its initial year in service. Variables included time from stroke alert (MSU dispatch) to brain CT in the field, treatment decision, tPA administration, and transport to a hospital stroke center. Time intervals from last seen normal were calculated for all patients. Study variables were compared for patients treated with thrombolysis on the MSU, and those who were not; and with reported times for other MSUs, and hospitals. Results: Between Jan. 15, 2016 and Jan. 9, 2017, 47 individuals received prehospital management with the UC MSU. Median age was 67 years (IQR 58-77), and 51% were female. Median initial NIH Stroke Scale score was 5 (IQR 2-11), and 36% were moderate to severe (NIHSS ≥8). Thirteen (28%) of patients were treated with IV tPA on the MSU. Median times from stroke alert to MSU arrival on the scene and first CT were 7 minutes (IQR 5-8), and 20 minutes (IQR 18-24), respectively. Median time to tPA administration was 39 minutes (IQR 35-45) from stroke alert, and 52 minutes (IQR 48-77) from the last time the patient was seen normal. Times from stroke alert and last seen normal to arrival at a stroke hospital were a median of 51 minutes (IQR 45-54) and 71 minutes (IQR 56-118), respectively. Conclusions: In this study of the initial year of an urban MSU’s operation, time intervals from stroke alert to initial brain CT imaging, neurologic evaluation and administration of thrombolysis were found to be substantially reduced compared to conventional, hospital-based stroke protocols, and some earlier MSUs. Intervals from last seen normal to these procedure time points were similarly reduced. These results suggest prehospital management with an MSU has potential to aid the goal of earlier thrombolysis after ischemic stroke symptom onset.

Reference genomes guide our interpretation of DNA sequence data. However, conventional linear references are fundamentally limited in that they represent only one version of each locus, whereas the population may contain multiple variants. When the reference represents an individual’s genome poorly, it can impact read mapping and introduce bias. Variation graphs are bidirected DNA sequence graphs that compactly represent genetic variation, including large scale structural variation such as inversions and duplications.1 Equivalent structures are produced by de novo genome assemblers.2,3 Here we present vg, a toolkit of computational methods for creating, manipulating, and utilizing these structures as references at the scale of the human genome. vg provides an efficient approach to mapping reads onto arbitrary variation graphs using generalized compressed suffix arrays,4 with improved accuracy over alignment to a linear reference, creating data structures to support downstream variant calling and genotyping. These capabilities make using variation graphs as reference structures for DNA sequencing practical at the scale of vertebrate genomes, or at the topological complexity of new species assemblies.

Egg identification and quantification are crucial to understanding the spawning and recruitment dynamics of economically important fish species. This study describes the development of a novel molecular method for finfish egg identification that eliminates the need for time-consuming microscopy. Sandwich hybridization assay (SHA) uses two ribosomal RNA (rRNA)-targeted oligonucleotides to directly detect unpurified and unamplified rRNA. Probes were designed to complement the internal transcribed spacer (ITS) region of the red drum (Sciaenops ocellatus), an important recreational game fish for which spawning and reproductive information is sparse. Sample homogenization procedures were modified to disrupt egg chorion, and the resultant assay detected S. ocellatus eggs and tissues without cross-reactivity. Standard curves were linear (y450 = 0.001x + 0.054; R2 = 0.999), showing potential for quantitative uses, and the lower limit of detection was 5 eggs·mL−1 homogenate. Ontogenetic stage had a significant effect (ANOVA, p < 0.05) on optical density. The assay successfully detected S.ocellatus eggs in field samples from Charleston Harbor, South Carolina, and could be incorporated into current management practices or adapted to other species.

This paper takes a multi-method approach, combining neuroscience methods and behavioral experiments to investigate emotions triggered by olfactory-related information and related consumer decision-making outcomes. In the online context, olfactory information is limited to visual forms of triggering olfactory sensations. The effectiveness of using sensory congruent brand names in online ads to trigger emotions, and the influence on attitudes toward the ad, brand and purchase intentions are examined. Moreover, individual differences in olfactory sensitivity were considered, revealing moderating effects on cognitive and emotional processes. Findings provide managerial and organizational implications for online advertising, branding decisions and market segmentation decisions.

The article explores the motivation of Thai secondary school students who chose to enroll in private tutorial institutes. The research draws on primary qualitative data compiled from structured interviews utilizing a comparative perspective to provide insight into perceptions of tutorial versus formal secondary education. The evidence presented here suggests that Thai secondary students have two clear motivations for consuming and engaging in private tutorial education: (1) the belief that tutorial classes will provide them with better educational performance as measured by their grade point average and performance on standardized tests, and (2) a service-driven motivation where tutorial educators provide student-centered learning and personalized education. The full text of the article can be found at 10.18275/fire201704021137

Europe United: Power Politics and the Making of the European Community. By Sebastian Rosato. Ithaca, NY: Cornell University Press, 2012. 280 pp., $35.00 hardcover (ISBN-13: 978-0-801-44935-2). Political Theory of the European Union. Edited by Jurgen Neyer, Antje Wiener. New York: Oxford University Press, 2011. 248 pp., $99.00 hardcover (ISBN-13: 978-0-199-58730-8). From the late 1990s throughout the 2000s, the subdisciplinary study of EU integration regarding its foundations and early history could be generalized as settling into an equilibrium of supranational/federalist (Haas 1968;Schmitter 1969; Hallstrom 2003; Benson and Jordan 2011) vs liberal/institutional intergovernmentalist (Gilbert 2003; Moravcsik 1991, 1998, 2000a,b) vs ideational perspectives (Parsons 2000, 2002, 2006). With the onset of the 2008 financial crisis and the deteriorating state of affairs surrounding the European Union, uncertainties on the future of European integration have taken center stage and given way to prescient questions which seek to re-open integration studies. The inherent weaknesses of economic and monetary union, which were hailed in the 1990s as the crowning achievement of an integrated Europe, have come into question. More pointedly, the fundamental nature and usefulness of European institutions in binding European states into peaceful cooperation has been brought into question. With internal and external instabilities undermining a half century of integration, the need to re-examine the state of European integration, explore the relationships that Europe has shared with its external partners, and shed fresh light on where the Union is heading has never been greater. Europe United , by Sebastian Rosato, contains six chapters that analyze early European integration from the immediate postwar period up to the Treaty of Rome and formation of the European Economic Community (EEC). He analyzes the European Coal and Steel Community (ECSC), European Defense Community (EDC), and EEC. The author focuses his study on Britain, France, and West Germany, finding consistent external geopolitical and internal (West European) security concerns determined balancing behavior in the early postwar period. His theoretical framework closely approximates an external and internal balance of power rational, materialist perspective. Rosato focuses and substantiates his historical inquiry by highlighting three …

Integrative learning in higher education is a rapidly developing area. At the University of South Carolina, a Living, Learning community led by a faculty principal is exploring new ways to connect students both within and beyond the classroom for the marine sciences. The Green Quad Living, Learning community has developed and implemented a co-curricular approach to marine science as part of the larger mission of educating residents on the environment and sustainability. Through the unique collaborations between two nationally recognized programs (University 101 and USC Connect), the Green Quad has become a leader in developing the Common Course program for marine science freshmen. We will illustrate the connections and lessons learned over the three year history of this program as well as future plans to grow the program.

Increasingly, marketing departments are recognizing the importance of teaching students the appropriate skills to adapt to the quickly evolving business environments (Granitz and Koernig 2011; Rinaldo et al. 2013; Tuten and Marks 2012; Wymbs 2011). This is especially relevant in marketing education where organizations expect marketing graduates to be equipped with skills in current information technologies used to manage communication with stakeholders and make complex data-driven marketing decisions (Granitz and Koernig 2011). Recent research indicates that at least some employers are currently dissatisfied with the technology skillsets of marketing graduates (Harrigan and Hulbert 2011; Kaplan et al. 2009). The purpose of this research is to determine whether there are significant differences in student attitudes toward faculty credibility, perceptions of learning, and attitudes toward digital marketing. We explore these questions within an experimental setting that manipulates whether the content of a digital marketing module was created by an industry expert versus academic and whether the delivery modality is face-to-face versus recorded. The results of this study reveal that whether or not an instructor presents themselves as from industry or academia and the modality of lecture delivery are important, though not interactive, factors in determining students’ perceptions toward a social media marketing lecture. Specifically, we find that in-person lecturing positively influences students’ perceptions of the lecturer across likeability, competence, character, and delivery variables. Face-to-face instruction was also positively associated with positive characteristics derived from a specific lecture such as how enjoyable it was and whether it should be taught to future classes.

BACKGROUND: Stroke often leaves its victims with devastating disabilities if not treated promptly. Guidelines recommend that brain imaging be obtained within 25 minutes, yet this benchmark is rarely achieved for the in-hospital stroke. PURPOSE: To reduce time to evaluation for strokes occurring in patients already hospitalized, through systematic analysis of current processes and application of standardized quality improvement methodology. METHODS: Improving the quality of care for in-hospital stroke patients involved 4 key steps: (1) creation of a detailed process map to identify inefficiencies in the current process for identifying and treating hospitalized stroke patients, (2) development of an optimized care pathway, (3) implementation of a checklist of optimal practices for the acute stroke response team and nursing staff, and (4) real-time feedback. Time from stroke alert to initiation of computed tomography (CT) scan was prospectively tracked for the 6-month period prior to intervention. After a 3-month interval for intervention roll-out, the response times for the pre-intervention period were compared to a 6-month post-intervention evaluation period. RESULTS: Pre-intervention median inpatient stroke alert-to-CT time was 69.0 minutes, with 19% meeting the goal of 25 minutes from alert to CT time. Post-intervention median inpatient stroke alert-to-CT time was reduced to 29.5 minutes, with 32% at goal (P < 0.0001). CONCLUSIONS: This inpatient stroke alert quality improvement initiative decreased median inpatient alert-to-CT time by 57%, and demonstrated that speed of in-hospital stroke evaluation can be improved through systematic application of quality improvement principles. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine

Genetic connectivity and habitat characteristics were examined in two species of Acesta clams (Bivalvia: Limidae) from submarine seamounts and continental slopes along the western North America margin. Two species were identified from dive videos obtained with submarine remotely operated vehicles that surveyed a 2200-km range between 27� and 46� N latitude. Acesta sphoni was only found at shallower habitats (545‐860 m depth) in the southern part of this range, whereas Acesta mori was more abundant and widely distributed in deeper habitats (1029‐1996 m). Both species occurred on seamounts and on the walls of submarine canyons and continental slopes. Segregation of these species by depth exposes them to correlated differences in water temperatures and dissolved oxygen concentrations. Ninety-eight individuals sampled from seven seamounts and one escarpment locality were characterized with DNA-barcodes based on 643 base pairs of mitochondrial cytochrome-c-oxidase subunit I (COI). Further analysis of these sequences revealed no significant geographical subdivision across the sampled range. This lack of differentiation suggests ongoing genetic exchange between the seamount populations and those possibly distributed along the continental margins. Examination of regional bathymetric profiles suggested that an abundance of suitable habitat might exist along these margins.

A sandwich hybridisation assay (SHA) has been developed to detect Asterias amurensis (Lutken 1871), commonly known as the northern Pacific seastar, which is an unwanted, and as yet undetected, pest in New Zealand waters. Probes in SHA format have been developed that target the ribosomal RNA internal transcribed spacer region of A. amurensis. The successful assay utilises the capture probe ITS-C2-110 and the combined signal probes ITS-S1-93 and ITS-S3-240. It has been successfully tested for specificity, including cross-reactivity testing against the common and related seastars, Patiriella regularis (Verrill 1867), P. mortenseni (O'Loughlin et al. 2002), Coscinasterias muricata (Verrill 1867) and Stichaster australis (Verrill 1871). The SHA is a rapid and potentially portable RNA-based test, and opens up the opportunity for direct analysis of water samples, for example, portside during surveillance of marine pests.

Background and Purpose— Approximately 4% to 17% of all adult strokes have onset in the hospital. Previous research indicates significant in-hospital evaluation delays and lower adherence to some measures of quality care compared to out-of-hospital strokes. Methods— Quality of care for in-hospital ischemic strokes compared to stroke with out-of-hospital onset was examined using cohort analysis of a statewide stroke database maintained by the Colorado Stroke Alliance. Results— One-hundred sixteen in-hospital strokes were compared to 4946 out-of-hospital strokes. Patients with in-hospital strokes were significantly more likely to have history of coronary artery disease (36.7% vs 26.5%; P =0.02), and in-hospital strokes were more severe (NIHSS score 9.5 vs 7.0; P =0.01). Time to brain imaging was not significantly different (54 minutes vs 43 minutes; P =0.13) between groups. Patients with in-hospital stroke were significantly more likely to have documentation of stroke education (90.4% vs 73.1%; P =0.0002) and assessment for rehabilitation (67.7% vs 45.2%; P P Conclusions— Adherence to GWTG-Stroke performance measures was better for in-hospital strokes in this statewide registry. Variability in reporting by participating hospitals suggests in-hospital strokes are under-recognized or under-reported. In-hospital stroke evaluation times remain more than twice the recommended benchmark of 25 minutes, representing an opportunity for process improvement.

The fields of biology and environmental health are undergoing an unprecedented transformation in the way communities are characterized and studied. One of the catalysts for this change has been the advent of high-throughput sequencing (aka next-generation sequencing). Though high-throughput sequencing is a relatively new concept, the principles behind it are fairly straightforward (PCR and pyrosequencing) and have been in the published literature since the early 1990s. Herein, I will highlight some of the more commonly encountered issues involving experimental design as well as important considerations for metagenomic sample collection (both quantity and quality) and data handling for high-throughput sequencing using the Roche/454 Life Sciences genome sequencing platform.

Individuals of an enteropneust, Tergivelum baldwinae n. gen., n. sp. were videotaped at a depth of about 4 km in the eastern Pacific and collected by a remotely operated vehicle. The living worms range in length from 9 to 28 cm and are dark brown anteriorly and beige posteriorly. The proboscis is shaped like a shallow dome, indented on either side by a laterodorsal fossa housing a prominent proboscis nerve. The collar comprises a thin transverse crest dorsally and two laterally projecting lips on either side of the mouth ventrally. The mouth is oriented parallel to the substratum and is flanked by large left and right buccal muscles (contrasting with the rudimentary musculature elsewhere in the body). The respiratory pharynx of the trunk extends far anteriorly so that much of it lies dorsal to the mouth opening. The gill bars are not joined by synapticles. The laterodorsal body wall at the anterior extremity of the trunk extends as two conspicuous flaps (back veils) that run posteriorly as unattached coverings over the anterior 30-50% of the trunk. On either side of the midline, the body wall of the trunk is extended as a narrow lateroventral fold. Within the trunk runs the intestine, which lacks hepatic sacculations and opens at an anus at the posterior end of the body. Frame analysis of videotapes suggests that the worm can secrete a mass of mucus around the body to facilitate demersal drifting from one epibenthic foraging site to the next. We include a preliminary phylogenetic analysis based on rDNA sequences from T. baldwinae n. gen., n. sp. and additional deep-sea enteropneusts not yet formally described taxonomically (sequence data place them unexpectedly close to ptychoderids). Until more is known about the group as a whole, it is prudent to leave family level classification of T. baldwinae n. gen., n. sp. as incertae sedis.