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Search Results: 1 - 10 of 404048 matches for " Rachel M. Gilmore "
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Female Gender Remains an Independent Risk Factor for Poor Outcome after Acute Nontraumatic Intracerebral Hemorrhage
Latha Ganti,Anunaya Jain,Neeraja Yerragondu,Minal Jain,M. Fernanda Bellolio,Rachel M. Gilmore,Alejandro Rabinstein
Neurology Research International , 2013, DOI: 10.1155/2013/219097
Abstract: Objective. To study whether gender influences outcome after intracerebral hemorrhage (ICH). Methods. Cohort study of 245 consecutive adults presenting to the emergency department with spontaneous ICH from January 2006 to December 2008. Patients with subarachnoid hemorrhage, extradural hemorrhage, and recurrence of hemorrhage were excluded. Results. There were no differences noted between genders in stroke severity (NIHSS) at presentation, ICH volume, or intraventricular extension (IVE) of hemorrhage. Despite this, females had 1.94 times higher odds of having a bad outcome (modified Rankin score (mRs) ) as compared to males (95% CI 1.12 to 3.3) and 1.84 times higher odds of early mortality (95% CI 1.02–3.33). analyzing known variables influencing mortality in ICH, the authors found that females did have higher serum glucose levels on arrival ( ) and 4.2 times higher odds for a cerebellar involvement than males (95% CI 1.63–10.75). After adjusting for age, NIHSS, glucose levels, hemorrhage volume, and IVE, female gender remained an independent predictor of early mortality ( ). Conclusions. Female gender may be an independent predictor of early mortality in ICH patients, even after adjustment for stroke severity, hemorrhage volume, IVE, serum glucose levels, and age. 1. Introduction Stroke is a priority public health problem for health systems worldwide today. Each year there are nearly 795,000 individuals who suffer from a new or recurrent stroke; 10% of these are cases of intracerebral hemorrhage. Stroke is the 4th leading cause of mortality according to the latest CDC statistics. Among all strokes, the case fatality rate for hemorrhagic strokes (37-38% mortality) is the highest [1], and most survivors have poor functional outcomes. Female gender has been recognized as an important risk factor for stroke, with NHANES reporting that women between 45 and 54 years of age were almost twice as likely to suffer from a stroke than males [2]. A greater decline was also seen in stroke-related deaths among males as compared to females between 1980 and 2005 [3]. There is a significant literature published on gender differences in outcomes of ischemic stroke. A recent review concluded that although the incidence of stroke was higher in males, females were more severely ill [4]. Internationally, it has been reported that the stroke burden is higher in females, because of a higher prestroke and poststroke disability [5–8]. This difference in disability after stroke between men and women is seen not only physically but also psychologically [9]. No published literature,
Prognostic Value of Complete Blood Count and Electrolyte Panel during Emergency Department Evaluation for Acute Ischemic Stroke
Latha Ganti,Rachel M. Gilmore,Amy L. Weaver,Robert D. Brown Jr.
ISRN Stroke , 2013, DOI: 10.1155/2013/974236
Abstract: Objective. To determine whether routine laboratory parameters are predictors of early mortality after acute ischemic stroke (AIS). Methods. The cohort consisted of 522 consecutive patients with AIS presenting to the emergency department (ED) at a tertiary referral center during a 27-month period, residing within the surrounding ten counties. Serum laboratory values were obtained for all patients and categorized according to whether the levels were low, normal, or high. These laboratory results were evaluated as potential predictors of 90-day mortality using Cox proportional hazards models. The associations were summarized by calculating risk ratios (RRs) and 95% confidence intervals (CI). Results. The presence of elevated white blood cell count (RR 2.2, 95% CI 1.5–3.4), low bicarbonate (RR 4.2, 95% CI 2.6–6.7), low calcium (RR 2.9, 95% CI 1.4–5.9), and high glucose (RR 1.3, 95% 1.1–1.6) were each univariately associated with significantly higher mortality within the first 90 days. Based on fitting a multivariate Cox regression model, elevated white blood cell count, low bicarbonate, and high glucose were each identified as being jointly associated with early mortality ( ). Conclusion. Early leukocytosis, acidosis, and hyperglycemia and hypocalcemia in AIS appear to be associated with early mortality. Whether addressing these factors will impact survival remains to be investigated. 1. Introduction For patients who present with chief complaint of acute ischemic stroke, the American Stroke Association recommends a set of diagnostic studies [1] to be done at presentation, with the intent of optimizing and expediting the care of these patients. From the Emergency Physicians’ perspective many tests are simply part of a routine battery, often without direct impact on emergency department (ED) management, diagnostic or prognostic value. In this study, we sought to determine whether the routine complete blood count (CBC) and electrolyte panel include any components that are markers of early mortality in acute ischemic stroke. Specifically, the parameters of interest were those obtained as part of routine clinical investigation. 2. Methods 2.1. Study Design This study was an observational study using a consecutive sample of local residents presenting to the ED with acute ischemic stroke (AIS). The primary outcome measure was death at 90 days. This study was approved by the Mayo Clinic Institutional Review Board. 2.2. Study Population and Setting This study was conducted at the Saint Marys Hospital, a tertiary referral academic medical center with an annual ED
Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation
Latha Ganti Stead,Rachel M. Gilmore,M. Fernanda Bellolio,Anunaya Jain,Alejandro A. Rabinstein,Wyatt W. Decker,Dipti Agarwal,Robert D. Brown Jr.
Stroke Research and Treatment , 2011, DOI: 10.4061/2011/281496
Abstract: Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence. Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality. Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center. Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year). Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity. 1. Introduction Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence. Certain stroke subtypes are associated with higher stroke severity at the time of presentation, which may account for the higher mortality seen. In 1993 the TOAST (Trail of ORG 10172 in Acute Stroke Treatment) investigators described a classification of AIS based on etiology, which is now the most commonly used etiological classification [1]. Comparison of clinical characteristics, functional outcomes, and mortality rates for specific ischemic stroke mechanisms may allow clinicians to identify those patients who are at higher risk and to evaluate treatment strategies more definitely. We conducted an observational study of all patients who presented to the emergency department (ED) with AIS and determined if ischemic stroke subtype (ISS) influences mortality even after correcting for stroke severity on initial presentation. 2. Methods This study was conducted at a tertiary care academic medical center, with an annual ED census of approximately
The impact of blood pressure hemodynamics in acute ischemic stroke: a prospective cohort study
Latha Stead, Sailaja Enduri, M Fernanda Bellolio, Anunaya R Jain, Lekshmi Vaidyanathan, Rachel M Gilmore, Rahul Kashyap, Amy L Weaver, Robert D Brown
International Journal of Emergency Medicine , 2012, DOI: 10.1186/1865-1380-5-3
Abstract: The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death).Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP.A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early deathStroke is associated with a high mortality and significant long-term functional disability. Of the 15 million patients affected by stroke worldwide yearly, the World Health Organization reports almost a third of these patients die, and another third are permanently disabled. Hypertension accounts for nearly 12.7 million strokes worldwide [1].Close to 80% of acute ischemic stroke (AIS) patients have an elevated blood pressure [2]. The elevation of blood pressure (BP) post-AIS has a multitude of causes, ranging from chronic hypertension and sympathetic stress response to stroke-related pathology itself [3]. Previous studies have shown tha
Primordial or Dynamical Mass Segregation in Young LMC Clusters?
Richard de Grijs,Gerry Gilmore,Rachel Johnson
Physics , 2002,
Abstract: We present the detailed analysis of Hubble Space Telescope observations of the spatial distributions of different stellar species in two young compact star clusters in the Large Magellanic Cloud, NGC 1805 and NGC 1818. Based on a comparison of the characteristic relaxation times in their cores and at their half-mass radii with the observed degree of mass segregation, it is most likely that significant primordial mass segregation was present in both clusters, particularly in NGC 1805. Both clusters were likely formed with very similar initial mass functions.
Dark Halos of Spiral Galaxies: ISO photometry
Gerard Gilmore,M. Unavane
Physics , 1998, DOI: 10.1046/j.1365-8711.1998.02062.x
Abstract: We exclude hydrogen burning stars, of any mass above the hydrogen-burning limit and any metallicity, as significant contributors to the massive halos deduced from rotation curves to dominate the outer parts of spiral galaxies. We present and analyse images of 4 nearly edge-on bulgeless spiral galaxies (UGC711, NGC2915, UGC12426, UGC1459) obtained with ISOCAM (The CAMera instrument on board the Infrared Space Observatory) at 14.5micron and 6.75micron. Our sensitivity limit for detection of any diffuse infrared emission associated with the dark halos in these galaxies is a few tens of microJy per 6arcsec x 6arcsec pixel, with this limit currently set by remaining difficulties in modelling the non-linear behaviour of the detectors. All four galaxies show zero detected signal from extended non-disk emission, consistent with zero halo-like luminosity density distribution. The 95percent upper limit on any emission, for NGC2915 in particular, allows us to exclude very low mass main sequence stars (M > 0.08 Msun), and young brown dwarfs (< 1 Gyr) as significant contributors to dark matter in galactic halos. Combining our results with those of the Galactic microlensing surveys, which exclude objects with M < 0.01 Msun, excludes almost the entire possible mass range of compact baryonic objects from contributing to galactic dark matter.
Near infrared star counts as a test of Galactic bar structure
M. Unavane,Gerard Gilmore
Physics , 1997, DOI: 10.1046/j.1365-8711.1998.29511267.x
Abstract: We present survey data in the narrow-band L filter (nbL), taken at UKIRT, for a total area of 277 square arcmin, roughly equally divided between four regions at zero Galactic latitude and longitudes +-4.3 deg and +-2.3 deg. The 80% completeness level for these observations is at roughly magnitude 11.0. This magnitude limit, owing to the low coefficient for interstellar extinction at this wavelength (A(nbL)=0.047 A(V)), allows us to observe bulge giants. We match the nbL-magnitudes with DENIS survey K magnitudes, and find 95 per cent of nbL sources are matched to K sources. Constructing colour-magnitude diagrams, we deredden the magnitudes and find evidence for a longitude dependent asymmetry in the source counts. We find that there are ~15% and ~5% more sources at the negative longitude than at the corresponding positive longitude, for the fields at +-4.3 deg and +-2.3 deg respectively. This is compared with the predictions of some Galactic bar models. We find an asymmetry in the expected sense, which favours gas dynamical models and the recent deconvolution of surface photometry data (Binney et al. 1991; Binney, Gerhard & Spergel 1997), over earlier treatments of photometric data (e.g. Dwek et al. 1995).
Mass Segregation in Young LMC Clusters
Richard de Grijs,Gerry F. Gilmore,Rachel A. Johnson
Physics , 2003,
Abstract: We present the detailed analysis of Hubble Space Telescope observations of the spatial distributions of different stellar species in two young compact star clusters in the Large Magellanic Cloud (LMC), NGC 1805 and NGC 1818. Based on a comparison of the characteristic relaxation times in their cores and at their half-mass radii with the observed degree of mass segregation, it is most likely that significant primordial mass segregation was present in both clusters, particularly in NGC 1805. Both clusters were likely formed with very similar initial mass functions (IMFs). In fact, we provide strong support for the universality of the IMF in LMC clusters for stellar masses m >= 0.8 M_sun.
Potential Inbreeding in a Small Population of a Mass Flowering Species, Xanthorrhoea johnsonii (Xanthorrhoeaceae): Is Your Mother My Father?  [PDF]
Rachel King, Jacinta M. Zalucki
American Journal of Plant Sciences (AJPS) , 2012, DOI: 10.4236/ajps.2012.33036
Abstract: Xanthorrhoea johnsonii is a long lived slow growing perennial understorey species, that produces a large quantity of passively dispersed seed every 3 - 5 years. Reproductive maturity is not reached until 20 - 30 years of age. The temporal asynchrony of the flowering event in this population was analogous to geographic isolation through fragmentation. A small population of plants flowering in isolation provided the opportunity to examine outcrossing rates, genetic diversity and the paternity of progeny at a small spatial scale (0.2 ha). The geographic location and physical characteristics of the adult plants were recorded, and both adults and their seed were sampled for genetic analysis. Four microsatellite loci were screened for genetic diversity and spatial structure analysis. A population outcrossing rate was estimated, as well as the number of paternal parents required to resolve the progeny multilocus genotypes. High genetic diversity was found in both adults and progeny with an estimated 97% outcrossing rate. All maternal lines required several paternal contributors, with no evidence of dominant paternal genotypes. Pollen transfer occurred between both geographically close and distant plants.
In Bangla There Is No Word for Vagina
—Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries
 [PDF]

Annekathryn Goodman, Mithila Faruque, Rachel M. Clark
Health (Health) , 2016, DOI: 10.4236/health.2016.812127
Abstract: Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.
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