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Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue‐defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue‐defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue‐defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue‐defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue‐defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361 [ABSTRACT FROM AUTHOR]

Background: Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients. Aim: To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients. Methods: Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared. Results: Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2–5) and 793 were without PD (baseline mRS 0–1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS. Conclusion: PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm. [ABSTRACT FROM AUTHOR]

The epoch of reionization (EoR) offers a unique window into the dawn of galaxy formation, through which high-redshift galaxies can be studied by observations of both themselves and their impact on the intergalactic medium. Line intensity mapping (LIM) promises to explore cosmic reionization and its driving sources by measuring intensity fluctuations of emission lines tracing the cosmic gas in varying phases. Using LIMFAST, a novel seminumerical tool designed to self-consistently simulate LIM signals of multiple EoR probes, we investigate how building blocks of galaxy formation and evolution theory, such as feedback-regulated star formation and chemical enrichment, might be studied with multitracer LIM during the EoR. On galaxy scales, we show that the star formation law and the feedback associated with star formation can be indicated by both the shape and redshift evolution of LIM power spectra. For a baseline model of metal production that traces star formation, we find that lines highly sensitive to metallicity are generally better probes of galaxy formation models. On larger scales, we demonstrate that inferring ionized bubble sizes from cross-correlations between tracers of ionized and neutral gas requires a detailed understanding of the astrophysics that shape the line luminosity–halo mass relation. Despite various modeling and observational challenges, wide-area, multitracer LIM surveys will provide important high-redshift tests for the fundamentals of galaxy formation theory, especially the interplay between star formation and feedback by accessing statistically the entire low-mass population of galaxies as ideal laboratories, complementary to upcoming surveys of individual sources by new-generation telescopes. [ABSTRACT FROM AUTHOR]

We present LIMFAST, a seminumerical code for simulating high-redshift galaxy formation and cosmic reionization as revealed by multitracer line intensity mapping (LIM) signals. LIMFAST builds upon and extends the 21cmFAST code widely used for 21 cm cosmology by implementing state-of-the-art models of galaxy formation and evolution. The metagalactic radiation background, including the production of various star formation lines, together with the 21 cm line signal tracing the neutral intergalactic medium (IGM), is self-consistently described by photoionization modeling and stellar population synthesis coupled to the galaxy formation model. We introduce basic structure and functionalities of the code, and demonstrate its validity and capabilities by showing broad agreements between the predicted and observed evolution of cosmic star formation, IGM neutral fraction, and metal enrichment. We also present the LIM signals of 21 cm, Ly α, H α, H β, [O ii ], and [O iii ] lines simulated by LIMFAST, and compare them with results from the literature. We elaborate on how several major aspects of our modeling framework, including models of star formation, chemical enrichment, and photoionization, may impact different LIM observables and thus become testable once applied to observational data. LIMFAST aims at being an efficient and resourceful tool for intensity mapping studies in general, exploring a wide range of scenarios of galaxy evolution and reionization and frequencies over which useful cosmological signals can be measured. [ABSTRACT FROM AUTHOR]

Objective: To describe COVID-19 illness characteristics, risk factors, and SARS-CoV-2 serostatus by variant time period in a large community-based pediatric sample. Design: Data were collected prospectively over four timepoints between October 2020 and November 2022 from a population-based cohort ages 5 to 19 years old. Setting: State of Texas, USA. Participants: Participants ages 5 to 19 years were recruited from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural clinical practices, health insurance providers, and a social media campaign. Exposure: SARS-CoV-2 infection. Main Outcome(s) and Measure(s): SARS-CoV-2 antibody status was assessed by the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Self-reported antigen or PCR COVID-19 test results and symptom status were also collected. Results: Over half (57.2%) of the sample (N = 3911) was antibody positive. Symptomatic infection increased over time from 47.09% during the pre-Delta variant time period, to 76.95% during Delta, to 84.73% during Omicron, and to 94.79% during the Omicron BA.2. Those who were not vaccinated were more likely (OR 1.71, 95% CI 1.47, 2.00) to be infected versus those fully vaccinated. Conclusions: Results show an increase in symptomatic COVID-19 infection among non-hospitalized children with each progressive variant over the past two years. Findings here support the public health guidance that eligible children should remain up to date with COVID-19 vaccinations. [ABSTRACT FROM AUTHOR]

Understanding the duration of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody Response Survey (Texas CARES) with at least 1 nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n = 4553) with 1 to 3 antibody tests over 11 months (1 October 2020 to 16 September 2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days postinfection, and predicts individuals may remain antibody positive from natural infection beyond 500 days depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not). [ABSTRACT FROM AUTHOR]

Accurate estimates of natural and/or vaccine-induced antibodies to SARS-CoV-2 are difficult to obtain. Although model-based estimates of seroprevalence have been proposed, they require inputting unknown parameters including viral reproduction number, longevity of immune response, and other dynamic factors. In contrast to a model-based approach, the current study presents a data-driven detailed statistical procedure for estimating total seroprevalence (defined as antibodies from natural infection or from full vaccination) in a region using prospectively collected serological data and state-level vaccination data. Specifically, we conducted a longitudinal statewide serological survey with 88,605 participants 5 years or older with 3 prospective blood draws beginning September 30, 2020. Along with state vaccination data, as of October 31, 2021, the estimated percentage of those 5 years or older with naturally occurring antibodies to SARS-CoV-2 in Texas is 35.0% (95% CI = (33.1%, 36.9%)). This is 3× higher than, state-confirmed COVID-19 cases (11.83%) for all ages. The percentage with naturally occurring or vaccine-induced antibodies (total seroprevalence) is 77.42%. This methodology is integral to pandemic preparedness as accurate estimates of seroprevalence can inform policy-making decisions relevant to SARS-CoV-2. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]