Search

We study firms’ decisions to provide non-GAAP income statements and the information environment consequences of Securities and Exchange Commission (SEC) comment letters directing them to stop disclosing such statements. We find firms voluntarily disclose non-GAAP income statements when firm and disclosure complexity, analyst following, and institutional ownership are higher. Using a difference-in-differences design, we find that, after firms stop disclosing full non-GAAP income statements at the direction of the SEC, the informativeness of non-GAAP earnings and overall earnings announcements decreases, information asymmetry increases, and analyst forecasts become less accurate and more disperse. We also find that firms not receiving a comment letter are more likely to stop providing non-GAAP income statements after an industry peer receives a non-GAAP income statement comment letter. Overall, our evidence suggests SEC comment letters about non-GAAP income statements appear to worsen the information environment for firms previously providing those statements. Data Availability: Data are available from the public sources cited in the text.

The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion.Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure.No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (β, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (β, 0.81; 95% CI, 0.72 to 0.90; P0.001), pharmacies used (β, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (β, 0.61; 95% CI, 0.50 to 0.74; P0.001), days of opioid prescription (β, 0.57; 95% CI, 0.45 to 0.72; P0.001), and morphine milligram equivalents prescribed (β, 0.53; 95% CI, 0.43 to 0.66; P0.001).PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors.4.

Purpose The novel coronavirus 2019 (COVID-19) pandemic provided new and various opportunities for corporate social responsibility (CSR) activities. This study intended to compare three types of CSR activities – product development, in-kind donation and CSR commercial – undertaken by two companies – Nike, Inc. and The Coca-Cola Company in response to the pandemic. The purpose of this study was to investigate how CSR activity type and their attributes affected effectiveness. Design/methodology/approach This study used an experiment using a 3 (CSR activity type) × 2 (company) mixed factorial design. CSR activity type was a between-subjects factor, and company was a within-subjects factor. The attributes of dynamism and innovativeness, corporate image, brand equity and social media sharing likelihood were dependent variables. Findings The findings underscored the importance of CSR activity type and their attributes of dynamism and innovativeness in the effects on corporate image and brand equity. Product development and in-kind donation, which were perceived as more dynamic than CSR commercial, resulted in more desirable corporate images. Product development, which was perceived as more innovative than in-kind donation and CSR commercial, did not result in greater brand equity than in-kind donation, but resulted in greater brand equity than CSR commercial. The CSR activity type and their attributes did not affect social media sharing likelihood. Differences in content modes could be considered. Originality/value This study advanced the knowledge on the effectiveness of CSR activities by comparing CSR activity types varying in dynamism and innovativeness in the context of a public health crisis that caused unprecedented societal changes and challenges.

This study examines the role of the Securities and Exchange Commission (SEC) in mergers and acquisitions (M&As) involving publicly traded target firms. We find that M&As receiving comment letters have an increased likelihood of deal completion and deal price revision, consistent with the SEC review process reducing information asymmetry, albeit at the cost of delaying the M&A process. We then provide evidence that the comment letter process generates new value-relevant information via firms’ disclosure amendments in response to comment letters. We address endogeneity concerns using multiple approaches. Our findings that the SEC review process reduces information asymmetry in M&As provide new insight into the real economic consequences of disclosure regulation.

Background The current preferred treatment for chronic hip and knee periprosthetic joint infection (PJI) involves both surgical intervention and antibiotic treatment as part of a two-stage revision. The purpose of this study is to determine how often patients who underwent a two-stage revision for chronic PJI developed a subsequent antibiotic-resistant infection. Methods We retrospectively reviewed the clinical records of 142 patients who underwent a two-stage revision for a chronic culture-positive PJI from January 2014 to May 2019. Demographic data and risk factors for PJI were identified. Resistance was defined in accordance with microbiology laboratory report and minimum inhibitory concentration. Statistical analysis consisted of descriptive statistics and univariate analysis. Results Only 10 of the 142 patients (7.04%) demonstrated emergence of resistance to antibiotics across their two-stage revision. At reimplantation, 25 (17.6%) patients had positive cultures. Of these, 16 patients presented with a novel organism and 9 patients had positive culture for the same organism as the initial infection. During the entire course of the two-stage revision, including spacer exchanges and irrigation and debridement procedures, 15 (10.56%) patients demonstrated persistent infections, whereas 25 (17.6%) patients presented with novel infections. 26 (18.3%) patients had reinfection of the same joint within one year. Conclusion In the given cohort, there does not appear to be a major emergence of antibiotic resistant organisms in patients undergoing two-stage exchange arthroplasty and antibiotic treatment.

China’s famed growth has created a paradox of huge proportions that is associated with how this development could happen despite the well documented issue of vast corruption. This growth has come through a specific form of corruption, changing from petty theft and speed money to grand theft and access money. The new forms of corruption were made possible through the access to assets like land, mines and State-Owned Enterprises (SOEs) after land-, property-, and SOE-reforms that were implemented during the 1990s. The opaque character of these reforms has led to what can only be described as a climate of grand collusion where officials use their access powers to redistribute what was formerly state-owned assets to themselves and crony entrepreneurs. While the character of corruption has changed over the last decade, the problem has not diminished despite continued official “anti-corruption” campaigns. The Chinese high growth/high corruption model has come with high risks growth and enormous inequality. Historically, Chinese dynasties have grown, decayed and fallen in scenarios similar to that of the present.

Background and Purpose: Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine). Methods: The screen failure log included 29 different reasons for exclusion. Chi-square statistics were used to evaluate the differences in reasons for exclusion between men and women. Results: A total of 38.2% of participants in iDEF were women. Three thousand nine hundred eighty-two women (45.7%) and 4736 men (54.3%) were screen failures ( P P =0.1). Patients or families declined participation in 1.26% of women versus 1.31% of men ( P =0.9). More women than men failed screening because of age>80 (22.40% versus 12.61%; adjusted P =0.0007) and preexisting do-not-resuscitate/do-not-intubate (3.69% versus 2.83%; adjusted P =0.067). Conclusions: Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women’s representation in future trials.

Background COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people’s views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people’s views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions This study suggests the public interest in and demand for information about vaccine development and people’s views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter.

This protocol was designed to detect acellular oxidative reactivity of nanoparticles

Despite ample research on brand engagement via social media, little research considers the aggregate effect of multiple same-brand accounts on engagement. Multiple same-brand accounts are common be...

Uranium-238 (238U), a long-lived radiometal, is widespread in the environment because of both naturally occurring processes and anthropogenic processes. The ingestion or inhalation of large amounts of U is a major threat to humans, and its toxicity is considered mostly chemical rather than radiological. Therefore, a way to remove uranium ingested by humans from uranium-contaminated water or from the air is critically needed. This study investigated the uranium uptake by hydroxyapatite (HAP), a compound found in human bone and teeth. The uptake of U by teeth is a result of U transport as dissolved uranyl (UO22+) in contaminated water, and U adsorption has been linked to delays in both tooth eruption and development. In this present work, the influence of pH, contact time, initial U concentration, and buffer solution on the uptake and removal of U in synthetic HAP was investigated and modeled. The influence of pH (pH of human saliva, 6.7-7.4) on the uptake of uranyl was negligible. Furthermore, the kinetics were extremely fast; in one second of exposure, 98% of uranyl was uptaken by HAP. The uptake followed pseudo-second-order kinetics and a Freundlich isotherm model. A 0.2 M sodium carbonate solution removed all the uranyl from HAP after 1 h. Another series of in vitro tests were performed with real teeth as targets. We found that, for a 50 mg/L U in PBS solution adjusted to physiological pH, ∼35% of the uranyl was uptaken by the tooth after 1 h, following pseudo-first-order kinetics. Among several washing solutions tested, a commercially available carbonate, as well as a commercially available fluoride solution, enabled removal of all the uranyl taken up by the teeth.

As the number of COVID-19 cases in the U.S. rises, the differential impact of the pandemic in urban and rural regions becomes more pronounced, and the major factors relating to this difference remain unclear. Using the 254 counties of Texas as units of analysis, we utilized multiple linear regression to investigate the influence of 83 county-level predictor variables including race demographics, age demographics, healthcare and financial status, and prevalence of and mortality rate from COVID-19 risk factors on the incidence rate and case fatality rate from COVID-19 in Texas on September 15, 2020. Here, we report that urban counties experience, on average, 41.1% higher incidence rates from COVID-19 than rural counties and 34.7% lower case fatality rates. Through comparisons between our models, we found that this difference was largely attributable to four major predictor variables: namely, the proportion of elderly residents, African American residents, and Hispanic residents, and the presence of large nursing homes. According to our models, counties with high incidence rates of COVID-19 are predicted to have high proportions of African American residents and Hispanic residents coupled with low proportions of elderly residents. Furthermore, we found that counties with the highest case fatality rates are predicted to have high proportions of elderly residents, obese residents, and Hispanic residents, coupled with low proportions of residents ages 20-39 and residents who report smoking cigarettes. In our study, major variables and their effects on COVID-19 risk are quantified, highlighting the most vulnerable populations and regions of Texas.

We study the winner’s curse in mergers and acquisitions, in which winning bidders fail to account for the uncertainty about target value and thus overpay. Using a unique setting where target firms hire multiple investment banks as advisors, we construct a novel measure of target valuation uncertainty based on investment banks’ disagreement on target valuation. We find that when valuation disagreement is higher, bidders pay significantly higher acquisition premiums. Moreover, bidders who pay high premiums have lower announcement returns and lower long-term post-merger returns when valuation disagreement is high. These bidders also create lower merger synergies. Our findings suggest that the winner’s curse does exist in takeovers and cause distortion in resource allocation.

Topic modeling, which uses machine learning algorithms to identify the emergence of topics, can help public health professionals monitor online public responses during health crises. This study used Latent Dirichlet Allocation algorithm to model the topics in Twitter messages (or “tweets”) from the US during the COVID-19 pandemic from March 20th to August 9th, 2020. Topic sizes and sentiment were calculated as the pandemic evolved, for major topics about vaccination and mask-wearing as a nonpharmaceutical intervention measure. Despite the pandemic, positive sentiments were found among most topics. While users were found to react more often to positive sentiment about mask-wearing, negative content on vaccination was found more popular. Noticeable trends in topic sizes and sentiment were observed for various topics, which correlated in time with some key pandemic events and policy changes, implying their impacts on social media responses. By analyzing such trends and impacts, this research offers insights on health campaign message design and how to outreach the general public most effectively.

We studied the T cell response to SARS-CoV-2 spike and non-spike peptide epitopes in eight convalescent pregnant women together with the immune monitoring that included innate tolerogenic dendritic cell populations important to maintain the immunological mother/fetus interface to address a potential risk for the antiviral cellular response in the outcome of pregnancy. Four subjects had pre-existing chronic inflammatory conditions that could have potentially affected the SARS-CoV-2-specific T cell response. Seven of eight subjects responded to SARS-CoV-2 peptides with differences within CD4+ T helper (Th) and CD8+ cytotoxic T cells (CTL). SARS-CoV-2-specific inducible regulatory T cells (iTreg) were numerous in circulation. CD4+ T cell memory included central memory T cells (TCM) and effector memory (TEM). As far as the CD8+ memory repertoire, TCM and TEM were very low or absent in eight of eight subjects and only effector cells that revert to CD45RA+, defined as TEMRA were measurable in circulation. T cells were in the normal range in all subjects regardless of pre-existing inflammatory conditions. The immune phenotype indicated the expansion and activation of tolerogenic myeloid dendritic cells including CD14+ cDC2 and CD4+ ILT-4+ tmDC. In summary, SARS-CoV-2 infection induced a physiological anti-viral T cell response in pregnant women that included SARS-CoV-2-specific iTreg with no negative effects on the tolerogenic innate dendritic cell repertoire relevant to the immune homeostasis of the maternal-fetal interface. All eight subjects studied delivered full-term, healthy infants.

The subject of homosexuality remains taboo in contemporary China, given that the public maintains a considerably negative attitude toward the subject. Recent Pew Research indicates that, on average, 21% of Chinese respondents believe that homosexuality should be accepted. However, parallel surveys of Internet users paint a different picture, as online surveys found a more liberal atmosphere toward homosexuality and same-sex marriage. The online and offline discrepancy in attitudes toward homosexuality begs the question of whether the Internet carries a stigma-reducing function in terms of views on sexual minority groups. Guided by the contact hypothesis and parasocial contact theory, the current study investigates the de-stigmatizing effect of the social media on homosexuality in China. A web-based survey with 980 social media users with a heterosexual orientation confirmed the positive role of interpersonal-mediated contact with lesbian and gay celebrities via social media venues in stigma reduct...

Background and Purpose— A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to stroke lesions in the subacute (eg, 30 days) and chronic phase has been correlated with poor motor outcomes, but it is unclear whether FA values obtained within the acute stroke phase (here defined as 80 hours after onset) can predict later outcome. Methods— Fifty-eight patients underwent an assessment of motor impairment in the acute phase and at 3 months using the upper extremity Fugl-Meyer assessment. FA values, obtained within 80 hours after stroke onset, were determined in 2 regions of interest: cerebral peduncle and a stretch of the CST caudal to each stroke lesion (nearest-5-slices). Results— The FA laterality index for the cerebral peduncle-regions of interest was a poor predictor of 3-month outcome ( R 2 =0.044; P =0.137), whereas the slope over the FA laterality index of the nearest-5-slices showed a relatively weak but significant prediction ( R 2 =0.11; P =0.022) with the affected side having lower FA values. Initial upper extremity Fugl-Meyer ( R 2 =0.69; P R 2 =0.71; P Conclusions— FA reductions of the CST can be detected near the ischemic lesion in the acute stroke phase, but offer minimal predictive value to motor outcomes at 3 months.

Objectives Recovery of independent ambulation after stroke is a major goal. However, which rehabilitation regimen best benefits each individual is unknown and decisions are currently made on a subjective basis. Predictors of response to specific therapies would guide the type of therapy most appropriate for each patient. Although lesion topography is a strong predictor of upper limb response, walking involves more distributed functions. Earlier studies that assessed the cortico‐spinal tract (CST) were negative, suggesting other structures may be important. Experimental Design: The relationship between lesion topography and response of walking speed to standard rehabilitation was assessed in 50 adult‐onset patients using both volumetric measurement of CST lesion load and voxel‐based lesion–symptom mapping (VLSM) to assess non‐CST structures. Two functional mobility scales, the functional ambulation category (FAC) and the modified rivermead mobility index (MRMI) were also administered. Performance measures were obtained both at entry into the study (3–42 days post‐stroke) and at the end of a 6‐week course of therapy. Baseline score, age, time since stroke onset and white matter hyperintensities score were included as nuisance covariates in regression models. Principal Observations: CST damage independently predicted response to therapy for FAC and MRMI, but not for walk speed. However, using VLSM the latter was predicted by damage to the putamen, insula, external capsule and neighbouring white matter. Conclusions Walk speed response to rehabilitation was affected by damage involving the putamen and neighbouring structures but not the CST, while the latter had modest but significant impact on everyday functions of general mobility and gait. Hum Brain Mapp 37:689–703, 2016. © 2015 Wiley Periodicals, Inc.

Objective The aim of this work was to investigate whether an imaging measure of corticospinal tract (CST) injury in the acute phase can predict motor outcome at 3 months in comparison to clinical assessment of initial motor impairment. Methods A two-site prospective cohort study followed up a group of first-ever ischemic stroke patients using the Upper-Extremity Fugl-Meyer (UE-FM) Scale to measure motor impairment in the acute phase and at 3 months. A weighted CST lesion load (wCST-LL) was calculated by overlaying the patient's lesion map on magnetic resonance imaging with a probabilistic CST constructed from healthy control subjects. Regression models were fit to assess the predictive value of wCST-LL and compared with initial motor impairment. Results Seventy-six patients (37 from cohort 1 and 39 from cohort 2) completed the study. wCST-LL as well as assessment of motor impairment (UE-FM) in the acute phase correlated with motor impairment (UE-FM) at 3 months in both cohort 1 (R2 = 0.69 vs. R2 = 0.67; p = 0.43) and cohort 2 (R2 = 0.69 vs. R2 = 0.62; p = 0.25). In the severely impaired subgroup (defined as UE-FM ≤ 10 at baseline), wCST-LL correlated with outcomes significantly better than clinical assessment (R2 = 0.47 vs. R2 = 0.11; p = 0.03). In the nonseverely impaired subgroup, stroke patients recovered approximately 70% of their maximal recovery potential. All stroke patients in both cohorts had poor motor outcomes at 3 months (defined as UE-FM ≤ 25) when wCST-LL was ≥ 7.0 cc (positive predictive value was 100%). Interpretation wCST-LL, an imaging biomarker determined in the acute phase, can predict poststroke motor outcomes at 3 months, especially in patients with severe impairment at baseline. Ann Neurol 2015

The present study provides a case comparison of crisis response strategies employed by sports organizations in the United States and the United Kingdom. In both crisis response and the broader body of corporate communications, cross-cultural comparisons of communication strategies are uncommon. Our findings have four significant implications: (1) they identify a statistically significant basis for the argument that communication strategy must be considered within a national culture context; (2) establish a comparative analysis of American and British approaches to economic crisis response; (3) provide a means to evaluate and identify other culturally-bound approaches to communications strategy; and (4) demonstrate the benefits of examining culture and crises using sports organizations.

The variable solid-state diffusivity (VSSD) and the resistive-reactant (RR) models that focus on different physical phenomena are used to investigate the solid-state transport (bulk effects) and electronic conductivity (surface effects) of LiFePO4 (LFP). For the first time, the models are effectively validated against experimental galvanostatic discharge data over a full range of applied currents. To achieve a reasonable degree of accuracy, particle-level parameters are estimated by fitting to experimental data obtained under low-rate discharge conditions, whereas electrode-level properties are derived based on high-rate conditions. Particle size distribution turns out to play a pivotal role in determining the rate capability of the electrode determined by the VSSD and a revised version of the RR model. Based on the full-range comparative study, both the resistive-reactant effect and bulk-related rate limitations prove to contribute significantly to the electrode polarization, especially at high C-rate. The resistive-reactant effect is expected to increase in an electrode made of smaller LFP particles. © 2013 The Electrochemical Society. [DOI: 10.1149/2.094401jes] All rights reserved.

The sorption of anthropogenic compounds on clay minerals is a complex molecular process with important implications for the fate of agrochemicals and organic pollutants in the environment. The present study illustrates the use of a water-mediated NOE approach to study clay binding interactions. This method exploits the interfacial water layer on clay surfaces as a hydrogen reservoir for magnetization transfer. The interactions of four different xenobiotics with clay suspension were investigated through this method to demonstrate its capability to screen for the clay–xenobiotic molecular affinity. Further, based on the NOE build-up rates, epitope map of clay–xenobiotic interactions can be generated, explaining the orientation and mechanism of the interactions. The water-mediated NOE approach has the potential to reveal key insights into the role that interfacial water plays in the binding process, providing a better understanding of the partitioning of anthropogenic compounds from bulk water into aqueous clay suspensions.

We examine how SEC comment letters asking firms to remove full non-GAAP income statements affect those firms’ information environments. Using a difference-in-difference design, we find that the informativeness of non-GAAP earnings and earnings announcements decreases, information asymmetry increases, and analyst forecasts become less accurate and (at least weakly) more disperse. We also study what drives firms’ decisions to provide non-GAAP income statements and find that firms voluntarily disclose non-GAAP income statements when analyst following and institutional ownership are higher and when firm and disclosure complexity is higher. In addition, we find that SEC scrutiny over non-GAAP income statement reporters decreases the likelihood industry peers will disclose non-GAAP income statements despite not receiving a comment letter. Our results are robust to a variety of robustness checks and falsification analyses. Overall, our evidence suggests SEC comment letters about full non-GAAP income statements worsen the information environment for firms previously providing those statements.

Objective: We sought to determine via a cross-sectional study the contribution of (1) the right hemisphere9s speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia. Methods: Fractional anisotropy (FA) of white matter regions underlying the right middle temporal gyrus (MTG), precentral gyrus (PreCG), pars opercularis (IFGop) and triangularis (IFGtri) of the inferior frontal gyrus, and the corpus callosum (CC) was correlated with speech fluency measures. A region within the superior parietal lobule (SPL) was examined as a control. FA values of regions that significantly predicted speech measures were compared with FA values from healthy age- and sex-matched controls. Results: FA values for the right MTG, PreCG, and IFGop significantly predicted speech fluency, but FA values of the IFGtri and SPL did not. A multiple regression showed that combining FA of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus—a previously identified biomarker of poststroke speech fluency—provided the best model for predicting speech fluency. FA of CC fibers connecting left and right supplementary motor areas (SMA) was also correlated with speech fluency. FA of the right IFGop and PreCG was significantly higher in patients than controls, while FA of a whole CC region of interest (ROI) and the CC-SMA ROI was significantly lower in patients. Conclusions: Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia. This may indicate premorbid anatomical variability beneficial for recovery or be the result of poststroke remodeling.

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

Improved prognostication during the acute phase of intracerebral hemorrhage (ICH) could influence goals of care. We investigated the utility of diffusion tensor imaging (DTI)-derived data obtained during the acute phase of ICH in predicting outcome, compared with the ICH score.We measured fractional anisotropy (FA) values in 5 slices below the level of the lesion on the affected and unaffected corticospinal tracts (CST) and in the cerebral peduncles (CPs) in 32 patients with supratentorial ICH who had DTI MRI within 4 days after ictus. We calculated the FA ratio (rFA = FAaffected side/FAunaffected side), and examined the value of the ICH score and rFA in predicting functional outcome assessed by modified Ranking Scale (mRS) at follow-up, using ROC analyses.The rFA values at the CPs level, but not the 5 slices below the lesion, were significantly lower in the group with poor functional outcome (defined as mRS 2) than in those with good functional outcome (0.96 ± 0.14 vs. 0.99 ± 0.08, p = 0.025). The ICH score had greater areas under ROC curve in predicting functional outcome compared to the mean rFA (AUC 0.74 vs. 0.44; p = 0.01 for mRS 2; and 0.84 vs. 0.40; p 0.001 for mRS 3).The prognostic value of the ICH score surpassed that of DTI-derived data during the acute phase of ICH in this cohort of patients. Prospective and larger studies are needed to validate our findings and to assess the prognostic role of various DTI-derived measures at different times following ICH.

Background: A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to ischemic stroke lesions in chronic stroke patients has been associated with poor motor outcome, but in the acute phase no clear FA trends have been observed or used to make outcome predictions. Methods: This study followed 40 patients with first-ever ischemic stroke, measuring motor impairment with the Upper Extremity Fugl-Meyer (UE-FM) acutely and at 3 months. Images obtained Results: Asymmetry between ipsilesional and contralesional CST FA values was significant different between patients with bad motor outcome and good outcome, with lower FA of the ipsilesional CST in the bad outcome group. No such asymmetry was seen for the cerebral peduncle ROI using either FA or ADC values. The FA laterality index for the nearest slice ROI was a significant but modest predictor of 3-month motor outcome (R2=0.186, p=.02), with the best predictive value offered by the combination of this imaging variable and the initial motor impairment (R2=0.696, p=.01). Conclusion: FA changes of the CST can be detected near the ischemic lesion in the acute phase after stroke, but these changes offer only modest predictive value for eventual motor outcome.

We previously showed that a combined variable of lesion site and size, the Arcuate Fasciculus lesion load (AF-LL), predicted speech fluency in chronic aphasic patients. In the current study, we compare the correlations between speech fluency and naming measures with two lesion markers in a large group of patients: the previously established structural lesion marker (i.e., AF-LL) and a new functional lesion marker (i.e., the functional grey matter lesion load (fGM-LL)). fGM-LL was constructed from functional brain imaging of overt speaking tasks in a group of twelve healthy elderly control participants. High-resolution structural brain images were acquired to reconstruct the arcuate fasciculus (AF) as a structural map. In addition to these two canonical maps, a combined AF-fGM was derived from summing fGM and AF maps. Each canonical map was overlaid with lesion masks of 50 chronic aphasic patients with varying degrees of impairment in speech production to calculate a functional and structural lesion load value for each patient. Lesion loads were then regressed with measures of speech fluency and naming. We found that both AF-LL and fGM-LL independently predicted speech fluency and naming ability (p