Use of a 3-item short-form version of the Barthel Index for use in stroke: systematic review and external validation

Background and Purpose—There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. Methods—We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). Results—From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. Conclusions—There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use

The biological embedding of early-life socioeconomic status and family adversity in children's genome-wide DNA methylation.

AimTo examine variation in child DNA methylation to assess its potential as a pathway for effects of childhood social adversity on health across the life course.Materials & methodsIn a diverse, prospective community sample of 178 kindergarten children, associations between three types of social experience and DNA methylation within buccal epithelial cells later in childhood were examined.ResultsFamily income, parental education and family psychosocial adversity each associated with increased or decreased DNA methylation (488, 354 and 102 sites, respectively) within a unique set of genomic CpG sites. Gene ontology analyses pointed to genes serving immune and developmental regulation functions.ConclusionFindings provided support for DNA methylation as a biomarker linking early-life social experiences with later life health in humans

Assemblage structure: an overlooked component of human-mediated species movements among freshwater ecosystems

The spread and impact of alien species among freshwater ecosystems has increased with global trade and human movement; therefore, quantifying the role of anthropogenic and ecological factors that increase the risk of invasion is an important conservation goal. Two factors considered as null models when assessing the potential for invasion are colonization pressure (i.e., the number of species introduced) and propagule pressure [i.e., the number (propagule size), and frequency (propagule number), of individuals of each species introduced]. We translate the terminology of species abundance distributions to the invasion terminology of propagule size and colonization size (PS and CS, respectively). We conduct hypothesis testing to determine the underlying statistical species abundance distribution for zooplankton assemblages transported between freshwater ecosystems; and, on the basis of a lognormal distribution, construct four hypothetical assemblages spanning assemblage structure, rank-abundance gradient (e.g., even vs uneven), total abundance (of all species combined), and relative contribution of PS vs CS. For a given CS, many combinations of PS and total abundance can occur when transported assemblages conform to a lognormal species abundance distribution; therefore, for a given transportation event, many combinations of CS and PS are possible with potentially different ecological outcomes. An assemblage exhibiting high PS but low CS (species poor, but highly abundant) may overcome demographic barriers to establishment, but with lower certainty of amenable environmental conditions in the recipient region; whereas, the opposite extreme, high CS and low PS (species rich, but low abundance per species) may provide multiple opportunities for one of n arriving species to circumvent environmental barriers, albeit with lower potential to overcome demographic constraints. Species abundance distributions and the corresponding influence of CS and PS are some of many influential factors (e.g., demographic and genetic stochasticity, environmental variability, composition of recipient ecosystems) that will help refine an understanding of establishment risk following the human-mediated movement of species

Metric Features of a Dipolar Model

The lattice spin model, with nearest neighbor ferromagnetic exchange and long range dipolar interaction, is studied by the method of time series for observables based on cluster configurations and associated partitions, such as Shannon entropy, Hamming and Rohlin distances. Previous results based on the two peaks shape of the specific heat, suggested the existence of two possible transitions. By the analysis of the Shannon entropy we are able to prove that the first one is a true phase transition corresponding to a particular melting process of oriented domains, where colored noise is present almost independently of true fractality. The second one is not a real transition and it may be ascribed to a smooth balancing between two geometrical effects: a progressive fragmentation of the big clusters (possibly creating fractals), and the slow onset of a small clusters chaotic phase. Comparison with the nearest neighbor Ising ferromagnetic system points out a substantial difference in the cluster geometrical properties of the two models and in their critical behavior.Comment: 20 pages, 15 figures, submitted to JPhys

Striped periodic minimizers of a two-dimensional model for martensitic phase transitions

In this paper we consider a simplified two-dimensional scalar model for the formation of mesoscopic domain patterns in martensitic shape-memory alloys at the interface between a region occupied by the parent (austenite) phase and a region occupied by the product (martensite) phase, which can occur in two variants (twins). The model, first proposed by Kohn and Mueller, is defined by the following functional: $${\cal E}(u)=\beta||u(0,\cdot)||^2_{H^{1/2}([0,h])}+ \int_{0}^{L} dx \int_0^h dy \big(|u_x|^2 + \epsilon |u_{yy}| \big)$$ where $u:[0,L]\times[0,h]\to R$ is periodic in $y$ and $u_y=\pm 1$ almost everywhere. Conti proved that if $\beta\gtrsim\epsilon L/h^2$ then the minimal specific energy scales like $\sim \min\{(\epsilon\beta/L)^{1/2}, (\epsilon/L)^{2/3}\}$, as $(\epsilon/L)\to 0$. In the regime $(\epsilon\beta/L)^{1/2}\ll (\epsilon/L)^{2/3}$, we improve Conti's results, by computing exactly the minimal energy and by proving that minimizers are periodic one-dimensional sawtooth functions.Comment: 29 pages, 3 figure

Aging in a Two-Dimensional Ising Model with Dipolar Interactions

Aging in a two-dimensional Ising spin model with both ferromagnetic exchange and antiferromagnetic dipolar interactions is established and investigated via Monte Carlo simulations. The behaviour of the autocorrelation function $C(t,t_w)$ is analyzed for different values of the temperature, the waiting time $t_w$ and the quotient $\delta=J_0/J_d$, $J_0$ and $J_d$ being the strength of exchange and dipolar interactions respectively. Different behaviours are encountered for $C(t,t_w)$ at low temperatures as $\delta$ is varied. Our results show that, depending on the value of $\delta$, the dynamics of this non-disordered model is consistent either with a slow domain dynamics characteristic of ferromagnets or with an activated scenario, like that proposed for spin glasses.Comment: 4 pages, RevTex, 5 postscript figures; acknowledgment added and some grammatical corrections in caption

Ferromagnetism and Temperature-Driven Reorientation Transition in Thin Itinerant-Electron Films

The temperature-driven reorientation transition which, up to now, has been studied by use of Heisenberg-type models only, is investigated within an itinerant-electron model. We consider the Hubbard model for a thin fcc(100) film together with the dipole interaction and a layer-dependent anisotropy field. The isotropic part of the model is treated by use of a generalization of the spectral-density approach to the film geometry. The magnetic properties of the film are investigated as a function of temperature and film thickness and are analyzed in detail with help of the spin- and layer-dependent quasiparticle density of states. By calculating the temperature dependence of the second-order anisotropy constants we find that both types of reorientation transitions, from out-of-plane to in-plane (``Fe-type'') and from in-plane to out-of-plane (``Ni-type'') magnetization are possible within our model. In the latter case the inclusion of a positive volume anisotropy is vital. The reorientation transition is mediated by a strong reduction of the surface magnetization with respect to the inner layers as a function of temperature and is found to depend significantly on the total band occupation.Comment: 10 pages, 8 figures included (eps), Phys Rev B in pres

Promoting Participant and Community Participation at Saddle Up!

This capstone project was completed through partnership with Saddle Up!, in Franklin, Tennessee. Saddle Up! is a nonprofit adaptive barn providing children and youth with disabilities the opportunity to grow and develop through therapeutic, educational, and recreational activities with horses. The primary focus of this project was to create a volunteer training manual for operating the mechanical lift. The deliverable was a PowerPoint which bridged the gap between instructor and volunteer knowledge. It included step by step instructions, as well as education on how to best support participants during the lift process. The secondary focus of the project was educating local organizations that serve children and youth with disabilities on Saddle Up’s Equine Assisted Learning (EAL) program. Education was provided to advocate for the EAL program, and how it benefits children and youth and with disabilities. The final focus of the project was to adapt and refurbish gait trainers for participant use to promote participation. After researching and consulting with experts, it was determined it was not best practice to utilize one gait trainer for multiple children. The deliverable included a resource to educate the staff of Saddle Up! on the purpose of gait trainers, and energy conservation techniques in order to promote participant participation

Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Background and Purpose—The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. Methods—Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery). Results—Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity. Conclusions—Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required

Speed impairs attending on the left: comparing attentional asymmetries for neglect patients in speeded and unspeeded cueing tasks

Visuospatial neglect after stroke is often characterized by a disengage deficit on a cued orienting task, in which individuals are disproportionately slower to respond to targets presented on the contralesional side of space following an ispilesional cue as compared to the reverse. The purpose of this study was to investigate the generality of the finding of a disengage deficit on another measure of cued attention, the temporal order judgment (TOJ) task, that does not depend upon speeded manual responses. Individuals with right hemisphere stroke with and without spatial neglect and older healthy controls (OHC) were tested with both a speeded RT cueing task and an unspeeded TOJ-with-cuing task. All stroke patients evidenced a disengage deficit on the speeded RT cueing task, although the size and direction of the bias was not associated with the severity of neglect. In contrast, few neglect patients showed a disengage deficit on the TOJ task. This discrepancy suggests that the disengage deficit may be related to task demands, rather than solely due to impaired attentional mechanisms per se. Further, the results of our study show that the disengage deficit is neither necessary nor sufficient for neglect to manifest