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Up-to-date certification of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) is often required for clinical trials, representing a significant burden on clinical investigators globally.
Aims:
This systematic review sought to determine if NIHSS or mRS training, re-training, certification or recertification led to improvements in the reliability or accuracy of ratings as well as other relevant user metrics (e.g., user confidence).
Results:
Among 4227 studies, 100 passed screening and were assessed for eligibility with full-text review; 23 met inclusion criteria. Among these 23 studies, 22 examined NIHSS training and/or certification, and only a single study included examined the effect of training on mRS performance. Ten of 23 included studies were conference abstracts. The study designs, interventions and outcome measurement of the included studies were heterogeneous. In the case of the NIHSS, two studies found increased accuracy after NIHSS training, and a third study showed statistically significant though clinically trivial decreases in error rate with training. The remaining 19 studies showed no benefit of NIHSS training as it relates to reliability or accuracy outcomes. The single included mRS study did not show the benefit of training.
Conclusion:
Although data are sparse with heterogeneous training protocols and outcomes, there is no compelling evidence to suggest benefit of healthcare professionals completing NIHSS or mRS training, certification or recertification. At the very least, recertification/re-training requirements should be reconsidered pending the provision of robust evidence.
Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External comparisons may help identify opportunities for improving prospective implementation.
We contend that if efficiency and reliability are important factors in neural information processing then distributed, not localist, representations are “evolution's best bet.” We note that distributed codes are the most efficient method for representing information, and that this efficiency minimizes metabolic costs, providing adaptive advantage to an organism.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
This study presents the first continuous record of fossil diatoms taken from an open spring-mound in southwestern United States. Diatoms were analyzed from a radiocarbon-dated core taken from Montezuma Well, a near thermally constant spring in northcentral Arizona. Fluctuations in total diatom density, oscillations in the relative abundance of Anomoeoneis sphaerophora, and intermittent deposition of calcite suggest that water levels in Montezuma Well underwent dramatic fluctuations to the degree of being intermittently dry, or at least very shallow, during the middle Holocene (∼8000-5000 yr B.P.). The fluctuations in water level probably correspond to oscillations in regional temperature and precipitation, which regulate hydrologic input and evaporation rates. The dramatic fluctuations in water level during the middle Holocene suggest that the endemic biota of Montezuma Well underwent relatively rapid speciation within the past ∼5000 yr. The appearance of endemic species (Gomphonema montezumense and Cyclotella pseudostelligera f. parva ) at ∼5000-3000 yr B.P. supports this hypothesis. Diatom indicators for organic enrichment (Aulacoseira granulata and A. islandica) closely coincide with the prehistoric native occupation of Montezuma Well.
Over the last 15 years, satellite-altimeter data have been used to produce surface-elevation maps of the Greenland and Antarctic ice sheets with a 2 m accuracy. Analysis of Seasat and Geosat cross-over points showed that satellite altimeters can measure changes in the mass balance of the ice sheets. The retracking algorithm used to extract surface elevations from Seasat and Geosat return wave forms is based upon a modified form of the Brown surface-scattering model. Recent work has shown that altimeter wave forms over higher-altitude regions of the ice sheets are affected by sub-surface volume-scattering. Here, we develop a theoretical model for altimeter return wave forms over the ice sheets that is based on a combination of surface-and volume-scattering. By approximating the altimeter’s antenna pattern and transmitted pulse shape with Gaussian functions, we derive a closed-form analytical solution for the return-power volume-scattered from beneath the ice-sheet surface. We then combine the volume-scattering model with the Brown model and apply it to average wave forms from the Greenland and Antarctic ice sheets. The results show that the combined model accurately describes variations in altimeter wave-form shapes that are produced by differing contributions of surface-and volume-scattering to the received power. The combined model is then used to simulate return wave forms from a dual-frequency altimeter. The simulation shows that a two-frequency system can provide quantitative estimates of the absorption and scattering coefficients for near-surface snow.
An X-band FM-CW radar was used to determine the feasibility of observing annual snow-accumulation layers in Antarctica with a high-resolution inexpensive radar system. The formation of layering boundaries, their resultant electromagnetic discontinuity and their detection by reflected energy are presented. Large returns from depths corresponding to reasonable positions for annual layers were found. The average accumulation rates calculated from the radar returns agree with those measured in a previous pit study done in the same area. The detection of the annual accumulation layers with this system implies a simple, inexpensive mobile radar could be used to profile large areas allowing the distorting effects of local topography to be removed.This type of system with a concurrent pit study could provide insight into the effect of sub-surface strata on spaceborne or airborne microwave remote sensing.
Weed science has contributed much to agriculture, forestry and natural resource management during its history. However, if it is to remain relevant as a scientific discipline, it is long past time for weed scientists to move beyond a dominating focus on herbicide efficacy testing and address the basic science underlying complex issues in vegetation management at many levels of biological organization currently being solved by others, such as invasion ecologists and molecular biologists. Weed science must not be circumscribed by a narrowly-defined set of tools but rather be seen as an integrating discipline. As a means of assessing current and future research interests and funding trends among weed scientists, the Weed Science Society of America conducted an online survey of its members in summer of 2007. There were 304 respondents out of a membership of 1330 at the time of the survey, a response rate of 23%. The largest group of respondents (41%) reported working on research problems primarily focused on herbicide efficacy and maintenance, funded mainly by private industry sources. Another smaller group of respondents (22%) reported focusing on research topics with a complex systems focus (such as invasion biology, ecosystem restoration, ecological weed management, and the genetics, molecular biology, and physiology of weedy traits), funded primarily by public sources. Increased cooperation between these complementary groups of scientists will be an essential step in making weed science increasingly relevant to the complex vegetation management issues of the 21st century.
The vertebrate record at the Ziegler Reservoir fossil site (ZRFS) near Snowmass Village, Colorado ranges from ~140 to 77 ka, spanning all of Marine Oxygen Isotope Stage (MIS) 5. The site contains at least 52 taxa of macro- and microvertebrates, including one fish, three amphibian, four reptile, ten bird, and 34 mammal taxa. The most common vertebrate is Ambystoma tigrinum (tiger salamander), which is represented by >22,000 elements representing the entire life cycle. The mastodon, Mammut americanum, is the most common mammal, and is documented by >1800 skeletal elements making the ZRFS one of the largest accumulations of proboscidean remains in North America. Faunas at the ZRFS can be divided into two groups, a lake-margin group dating to ~140–100 ka that is dominated by woodland taxa, and a lake-center group dating to ~87–77 ka characterized by taxa favoring more open conditions. The change in faunal assemblages occurred between MIS 5c and 5a (vertebrates were absent from MIS 5b deposits), which were times of significant environmental change at the ZRFS. Furthermore, the ZRFS provides a well-dated occurrence of the extinct Bison latifrons, which has implications for the timing of the Rancholabrean Mammal Age in the region.
Medical education often presents new material as large data dumps at a single live event (lecture or symposium), in part because it is traditional, and also because this structure can be perceived as the most time efficient for busy clinicians and their teachers. However, modern learning theory and new insights from the neurobiological basis of long-term memory formation show that the format of single-event presentation of materials is not very effective. Rather, seeing the presentation of new materials over time, in bite-sized chunks, and then seeing them again at a later time, particularly as a test, leads to more retention of information than does learning the same amount of material as a large bolus in a single setting. This notion of learning over time, also called “interval learning” or “spaced learning,” is particularly well adapted to the Internet era. Here we describe an application of this concept to the learning of psychopharmacology over time in bite-sized and repeated portions structured as an “online fellowship” called the Master Psychopharmacology Program (www.neiglobal.com/mpptour).
This study aimed to determine the feasibility of using likelihood of inadequate therapy (LIT), a parameter calculated by using pathogen frequency and in vitro susceptibility for determination of appropriate empiric antibiotic therapy for primary bloodstream infections. Our study demonstrates that LIT may reveal differences in traditional antibiograms.