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Background and Purpose-Faster treatment with intravenous tissue-type plasminogen activator (tPA) is likely to improve outcomes. Optimizing prehospital triage by mobile stroke units (MSUs) may speed treatment times. The Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit (BEST-MSU) study was launched in May 2014 using the first MSU in the United States to compare stroke management using an MSU versus standard management (SM). Herein, we describe the results of the prespecified, nonrandomized run-in phase designed to obtain preliminary data on study logistics. Methods-The run-in phase consisted of 8 MSU weeks when all-patient care occurred on the MSU and 2 SM weeks when the MSU nurse met personnel on scene or at the emergency department to ensure comparability with MSU patients.Telemedicine was independently performed in 9 MSU cases. Results-Of 130 alerts, 24 MSU and 2 SM patients were enrolled. Twelve of 24 MSU patients received tPA on board; 4 were treated within 60 minutes of last seen normal, and 4 went on to endovascular treatment. There were no hemorrhagic complications. Four had primary intracerebral hemorrhage. Agreement on tPA eligibility between the onsite and telemedicine physician was 90%. Conclusions-The run-in phase provided a tPA treatment rate of 1.5 patients per week, assured us that treatment within 60 minutes of onset is possible, and enabled enrollment of patients on SM weeks. We also recognized the opportunity to assess the effect of the MSU on endovascular treatment and intracerebral hemorrhage. Challenges include the need to control biased patient selection on MSU versus SM weeks and establish inter-rater agreement for tPA treatment using telemedicine.

ORCID ID: 0000-0001-5462-524X (J.P.).Dicot leaves are composed of a heterogeneous mosaic of jigsaw puzzle piece-shaped pavement cells that vary greatly in size and the complexity of their shape. Given the importance of the epidermis and this particular cell type for leaf expansion, there is a strong need to understand how pavement cells morph from a simple polyhedral shape into highly lobed and interdigitated cells. At present, it is still unclear how and when the patterns of lobing are initiated in pavement cells, and one major technological bottleneck to addressing the problem is the lack of a robust and objective methodology to identify and track lobing events during the transition from simple cell geometry to lobed cells. We developed a convex hull-based algorithm termed LobeFinder to identify lobes, quantify geometric properties, and create a useful graphical output of cell coordinates for further analysis. The algorithm was validated against manually curated images of pavement cells of widely varying sizes and shapes. The ability to objectively count and detect new lobe initiation events provides an improved quantitative framework to analyze mutant phenotypes, detect symmetry-breaking events in time-lapse image data, and quantify the time-dependent correlation between cell shape change and intracellular factors that may play a role in the morphogenesis process.

Purpose The purpose of this paper is to explore the applicability of blockchain technology in international trade process from a perspective of letter of credit payment. Design/methodology/approach A blockchain-based re-engineering process is designed by employing the blockchain and its affiliated smart contract technology to harvest the benefits of distributed ledger and distributed business workflow automation. Findings Comparative analysis and feasibility study were conducted to identify and validate the prospects, in terms of facilitating process flow and enhancing overall trade performance, of the proposed blockchain-based international trade process model. Practical implications Traditional trade processes suffer from a great number of issues about intermediaries, information latency and trust, which, in turn, hinder overall process efficiency. The emerging blockchain technology may have potentials to mitigate those issues by revolutionizing business processes across enterprise borders in various industries. Originality/value This study contributes to the conceptual design of a blockchain- and smart-contract-based process along with a provision of practical case in business process re-engineering. Further endeavors devoted to blockchain research and application across different sectors are suggested to reach better performance of business process operations.

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