IMPORTANCE Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter clinical trials. OBJECTIVE To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, phase 3, multisite, randomized clinical trial of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013. INTERVENTIONS Blood product ratios of 1:1:1 (338 patients) vs 1:1:2 (342 patients) during active resuscitation in addition to all local standard-of-care interventions (uncontrolled). MAIN OUTCOMES AND MEASURES Primary outcomes were 24-hour and 30-day all-cause mortality. Prespecified ancillary outcomes included time to hemostasis, blood product volumes transfused, complications, incidence of surgical procedures, and functional status. RESULTS No significant differences were detected in mortality at 24 hours (12.7% in 1:1:1 group vs 17.0% in 1:1:2 group; difference, −4.2% [95% CI, −9.6% to 1.1%]; P = .12) or at 30 days (22.4% vs 26.1%, respectively; difference, −3.7% [95% CI, −10.2% to 2.7%]; P = .26). Exsanguination, which was the predominant cause of death within the first 24 hours, was significantly decreased in the 1:1:1 group (9.2% vs 14.6% in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P = .03). More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group (86% vs 78%, respectively; P = .006). Despite the 1:1:1 group receiving more plasma (median of 7 U vs 5 U, P < .001) and platelets (12 U vs 6 U, P < .001) and similar amounts of red blood cells (9 U) over the first 24 hours, no differences between the 2 groups were found for the 23 prespecified complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. CONCLUSIONS AND RELEVANCE Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01545232

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed brief, comprehensive, and reliable batteries of clinical and neuropsychological tests for assessment of patients with the clinical diagnosis of Alzheimer's disease (AD). We administered these batteries in a standardized manner to more than 350 subjects with a diagnosis of AD and 275 control subjects who were enrolled in a nationwide registry by a consortium of 16 university medical centers. The tests selected for this study measured the primary cognitive manifestations of AD across a range of severity of the disorder, and discriminated between normal subjects and those with mild and moderate dementia. The batteries also detected deterioration of language, memory, praxis, and general intellectual status in subjects returning for reassessment 1 year later. Interrater and test-retest reliabilities were substantial. Long-term observations of this cohort are in progress in an effort to validate the clinical and neuropsychological assessments and to confirm the diagnosis by postmortem examinations. Although information on validation is limited thus far, the CERAD batteries appear to fill a need for a standardized, easily administered, and reliable instrument for evaluating persons with AD in multicenter research studies as well as in clinical practice.

Obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and an approximately 25% decrease in odds of substance use disorders. Variation across demographic groups suggests that social or cultural factors may moderate or mediate the association between obesity and mood disorder.

We present interferometric angular diameter measurements of 21 low-mass, Kand M-dwarfs made with the CHARA Array. This sample is enhanced by adding a collection of radii measurements published in the literature to form a total data set of 33 K-M dwarfs with diameters measured to better than 5%. We use these data in combination with the Hipparcos parallax and new measurements of the star's bolometric flux to compute absolute luminosities, linear radii, and effective temperatures for the stars. We develop empirical relations for ∼K0 to M4 mainsequence stars that link the stellar temperature, radius, and luminosity to thebroad-band color index and stellar metallicity [Fe/H]. These relations are valid for metallicities ranging from [Fe/H] = −0.5 to +0.1 dex, and are accurate to ∼2%, ∼5%, and ∼4% for temperature, radius, and luminosity, respectively. Our results show that it is necessary to use metallicity dependent transformations in order to properly convert colors into stellar temperatures, radii, and luminosities. Alternatively, we find no sensitivity to metallicity on relations we construct to the global properties of a star omitting color information e.g., temperature-radius and temperatureluminosity. Thus, we are able to empirically quantify to what order the star's observed color index is impacted by the stellar iron abundance. In addition to the empirical relations, we also provide a representative look-up table via stellar spectral classifications using this collection of data. Robust examinations of single star temperatures and radii compared to evolutionary model predictions on the luminosity -temperature and luminosity -radius planes reveals that models overestimate the temperatures of stars with surface temperatures < 5000 K by ∼ 3%, and underestimate the radii of stars with radii < 0.7 R ⊙ by ∼ 5%. These conclusions additionally suggest that the models over account for the effects that the stellar metallicity may have on the astrophysical properties of an object. By comparing the interferometrically measured radii for the single star population to those of eclipsing binaries, we find that for a given mass, single and binary star radii are indistinguishable. However, we also find that for a given radius, the literature temperatures for binary stars are systematically lower compared to our interferometrically derived temperatures of single stars by ∼ 200 to 300 K. The nature of this offset is dependent on the validation of binary star temperatures; where bringing all measurements to a uniform and correctly calibrated temperature scale is needed to identify any influence stellar activity may have on the physical properties of a star. Lastly, we present a empirically determined HR diagram using fundamental properties presented here in combination with those in Boyajian et al. (2012) for a total of 74 nearby, main-sequence, A-to M-type stars, and define regions of habitability for the potential existence of sub-stellar mass companions in each system.

Our dementia and AD incidence rates are consistent with recent US and European cohort studies, providing clinicians and researchers new information concerning the reproducibility of incidence estimates across settings. Increased risk was associated with age and the apolipoprotein E genotype; also with a low baseline cognitive screening test score. Educational level was inversely associated with the risk of dementia and positively associated with the baseline cognitive test score; thus, detection of AD by the screening test could also be influenced by educational level.

An explicit means of calculating the expected number of species [E(Sn)] and the variance of (Sn) in a random sample of n individuals from a collection containing N individuals and S species is presented. An example illustrates a new use of E(Sn): determination of the sample size required for any desired degree of accuracy in collecting species known to occur in a particular area.

Reliable information on rate of progression of cognitive impairment in probable Alzheimer's disease (AD) is important for evaluating possible beneficial effects of therapeutic agents and in planning long-term care for patients with this chronic illness. However, wide variability exists in published rates of change for psychometric measures of the dementing process, and there is need for an accurate analysis of large numbers of persons with the disorder studied over long periods. Utilizing the large, well-characterized sample of the Consortium to Establish a Registry for Alzheimer's Disease and employing a least squares regression method to adjust for different levels of impairment and periods of observation, we report rates of change on the Short Blessed Test, Mini-Mental State Examination, Blessed Dementia Scale, Clinical Dementia Rating, and other cognitive measures in 430 patients with probable AD (mean age at entry = 70.9 +/- 8.0 SD years) studied for up to 4 years. We found that rate-of-change determinations are less reliable when the observation period is 1 year or less, that dementia progression may be nonlinear when described by certain measures, and that simple change scores do not accurately characterize the rate of decline. We also found that rate of progression in AD is determined by the severity of cognitive impairment: the less severe the dementia, the slower the rate of decline.

Two procedures, the jackknife and the bootstrap, are discussed as methods for estimating the number of species by the sampling of quadrats. Explicit formulas for both procedures are presented and evaluated under a model with a random distribution of individuals. The jackknife and bootstrap are shown to reduce the bias although they underestimate the actual number of species if there is a large number of rare species and the number of quadrats sampled is small. When a small number of quadrats is sampled, the jackknife is shown to give better estimates. When the number of quadrats is large, the jackknife tends to overestimate the number of species and the bootstrap performs better.