\n\nMethods We examined primary outcomes by National Institutes of Health selleckchem Stroke Scale (NIHSS), Barthel Index (BI) and modified Rankin Scale (mRS), and QoL by Stroke Impact Scale (SIS) and European Quality of Life Scale (EQ-5D) from the Virtual International Stroke Trials Archive (VISTA). Using Spearman correlations and logistic
regression, we described the relationships between QoL mRS, NIHSS, and BI at 3 months, stratified by respondent (patient or proxy). Using (2) analyses, we examined the mismatch between good primary outcome (mRS 1, NIHSS 5, or BI 95) but poor QoL, and poor primary outcome (mRS 3, NIHSS 20, or BI 60) but good QoL.\n\nResults Patient-assessed QoL had a stronger association with mRS (EQ-5D weighted score n=2987, P<0.0001, r=-0.7, r(2)=0.53; SIS recovery n=2970, P<0.0001, r=-0.71, r(2)=0.52). Proxy responses had a stronger association with BI
(EQ-5D weighted score n=837, P<0.0001, r=0.78, r(2)=0.63; SIS recovery n=867, P<0.0001, r=0.68, r(2)=0.48). mRS explained more of the variation in QoL (EQ-5D weighted score=53%, recovery by SIS v3.0=52%) than NIHSS or BI and resulted in fewer mismatches between good primary outcome and poor QoL (P<0.0001, EQ-5D weighted score=8.5%; SIS recovery=10%; SIS-16=4.4%).\n\nConclusions The mRS seemed to align closely with stroke survivors’ interests, capturing more information on QoL than either NIHSS or BI. This further supports its recommendation as a primary outcome measure in acute stroke randomized controlled trials.”
“The causes of megafaunal extinctions in North America have been widely Small molecule library price debated but remain poorly understood. Mammoths (Mammuthus spp.) in the American Southwest were hunted by Clovis people during a period of rapid climate change, just before the regional onset of Younger Dryas cooling and mammoth extirpation. Thus, these mammoths may provide key insights into late Pleistocene
extinction processes. Here we reconstruct the seasonal diet and climatic conditions experienced by mammoths in the San Pedro Valley of Arizona, using the carbon (C-13/C-12) and oxygen (O-18/O-16) isotope compositions BTSA1 of tooth enamel. These records suggest that Clovis mammoths experienced a warm, dry climate with sufficient summer rainfall to support seasonal C-4 plant growth. Monsoon intensity may have been reduced relative to the preceding time period, but there is no isotopic evidence for severe drought. However, it is possible that the “Clovis drought”, inferred from stratigraphic evidence, occurred suddenly at the end of the animals’ lives and thus was not recorded in the enamel isotopic compositions. Unlike mammoths that lived before the Last Glacial Maximum, Clovis mammoths regularly increased C-4 grass consumption during summer, probably seeking seasonally green grasslands farther from the river valley. This predictable seasonal behavior may have made mammoths easier to locate by Clovis hunters.