Cincinnati Region Research Articles

Traces of missing encrusters: borings reveal sclerobiont taphonomy in the Upper Ordovician (Katian) of the Cincinnati region, USA

ABSTRACT The abundant shells and hardgrounds in the Cincinnatian Group (Upper Ordovician, Katian) of the upper midwestern United States were commonly encrusted and bored by a variety of organisms. Numerous studies of these sclerobiont communities have provided valuable data for models of ecological succession, symbiosis, space and food resource competition, and taphonomy. An underlying assumption of this work is that most of the skeletal encrusters have remained in place, firmly attached to their hard substrates. This is especially the case with the most common encrusters, thick trepostome bryozoan and cystoporate skeletons, on their most common substrates, flat strophomenide brachiopods. We present evidence here, though, that these bryozoans were often dislodged from their brachiopod hosts, leaving no evidence of their attachment other than horizontal borings in semi-relief from organisms that excavated tunnels (Trypanites and Palaeosabella) at the interface of the brachiopod shell and attaching bryozoan. Similar borings are found on the bases of dislodged bryozoans and in bryoimmured mollusc external moulds. These borings along the bryozoan attachment surfaces caution us that there are significant numbers of missing skeletal encrusters on these hard substrates.

The “Guttenberg” positive δ13C excursion (GICE) interval of Latest Sandbian–early Katian (Late Ordovician) spans ca. 1.2 Myr in Asian reference sections

The boundary between the Sandbian and Katian stages of the Late Ordovician is directly followed by the onset of the Guttenberg positive isotope carbon excursion (GICE), which is potentially a means to aid in global correlation of this stage boundary. The sedimentary record of the GICE in mid-continent North American sections often spans only a few meters and has been estimated to span <400 kyr. In contrast, a major sustained positive excursion that has been considered equivalent to the GICE spans over 100 m within some other sections in North America and in the Qilang Formation of the Tarim Basin in northwest China. In addition to enhancing the carbon-isotope records of this expanded record of the GICE, we applied cyclostratigraphy analysis to detailed natural-gamma logging from the Dawangou section, Tarim Basin, which is the auxiliary GSSP for the Sandbian Stage, and from the nearby Sishichang section. The average proportion of carbonate to marl in the outer shelf facies of these sections exhibits cycles of ca. 30 m. Superimposed on these large-scale cycles are ca. 1.5-m oscillations. We interpret these cycles as a sedimentary record of long-eccentricity (405 kyr) and precession cycles. Three secondary low-amplitude oscillations in δ13C are superimposed on the broad GICE plateau and are in phase with the long-eccentricity cycles. The astronomical-tuned sedimentary stratigraphy of these sections implies that the main GICE interval has a duration of ca. 1.2 Myr, with an uncertainty of ca. 200 kyr depending upon how the onset and termination of the GICE is defined. Similar secondary peaks in δ13C on the main GICE excursion reported from other regions have been termed G1, G2 and G3. In the Dawangou section, the estimated placement of the Sandbian-Katian stage boundary is midway between G1 and G2. The GICE record in the composite δ13C stratigraphy from the Cincinnati region of Ohio-Kentucky exhibits an initial “Logana” positive excursion followed by a “Macedonia” positive excursion, and we suggest that these are correlative to the G2 and G3 secondary peaks on the broad GICE as identified in Asia. In both the Tarim region and in the Cincinnati composite, these two secondary peaks in δ13C occur during intervals of greater clay content relative to carbonate. If verified, this astronomically tuned reference scale of the δ13C modulations will enable high-resolution global correlation of biozones and other events near the Sandbian-Katian stage boundary and during the Early Katian.

Abstract TMP102: Timing Of Withdrawal Of Antithrombotics And Impact On Stroke

Background: Antithrombotic medications (AT) are often withheld before procedures to reduce risk of bleeding. In 2005, members of our team reported that 5.2% of ischemic strokes were associated with the withdrawal of AT in the preceding 60 days. Subsequently, new medications, including DOACs, have become widely used. Given changing prescription and practice patterns we sought to compare rates of stroke in the setting of antithrombotic withdrawal in 2010 and 2015. Methods: The GCNKSS is a population-based stroke study from the Greater Cincinnati region. In 2005, 2010, and 2015, we captured all strokes in the Greater Cincinnati/Northern Kentucky 5 county area by screening ICD9 codes 430-436 and ICD10 (2015) codes I60-I68, and G45-46. Study nurses abstracted all cases and physicians adjudicated each event. Data regarding the withdrawal of AT and timing were captured. 2005 data was included as a reference. Fisher’s exact test was used to examine differences by years. Results: In 2010 and 2015, 4768 cases of ischemic stroke were identified. Across the study periods, those that were on AT at time of stroke versus those who stopped AT &lt;60 days prior to incident stroke were of similar median age, 73 and 74 years respectively, and of similar sex (55 vs 52%) and race (21 vs 18%) distribution. Atrial fibrillation (30 vs 52%) and median baseline NIHSS (3 vs 4) were higher in those who stopped AT &lt; 60 days prior to stroke than those on AT. Of the 4768, 228 (4.8%) occurred within 60 days of withdrawal of an antithrombotic medication. The proportion of strokes in the setting of warfarin being held is the only AT that had a significant change, decreasing in 2015 (Table). Conclusions: The withdrawal of AT is associated with 228 (4.8%) of ischemic strokes within 60 days in our study population. These rates remain consistent across our study periods. This highlights that despite new agents, stroke in the setting of AT withdrawal remains consistent and the decision to stop AT must be carefully considered.

A Geographic Perspective on Opioid Misuse: Substance Abuse Treatment Deserts in Southwestern Ohio

Background: The opioid crisis is one of the most pressing public health issues facing Ohio, with an impact uneven-ly distributed across the state. This work examined geographical barriers to substance abuse treatment in southwestern Ohio through examining geographical areas with limited access to substance abuse treatment services and identifying substance abuse treatment deserts. Methods: The study domain included the 13 counties in the Ohio Mental Health and Addiction Service's Cincinnati region. Publicly available substance use disorders treatment data were collected from government agency resources, pharmaceutical websites, and web searches. Substance abuse treatment deserts were defined as areas in the 13-county study area that were not within a 15-minute drive from a treatment center. Results: We found large portions of the study region that were considered a substance abuse treatment desert for methadone and naltrexone/buprenorphine clinics, behavioral health treatment centers, and both medicated assisted treatment (MAT) and behavioral health treatment combined. Out of the 2 017 337 total persons living in the 13-county study area, 17% (n = 342 872) live in a desert for all MAT and behavioral treatment. Similarly, 19.7% (n = 396 581) live in a desert for naltrexone/buprenorphine treatment, 60.9% (n = 1 227 560) live in a desert for methadone treatment, and 19.7% (n = 396 581) live in a desert for behavioral health treatment. Conclusion: We successfully defined substance abuse treatment deserts in southwestern Ohio, which will be useful for future research to determine its association with opioid-related health outcomes. This resource is publicly available online (https://doi.org/10.5281/zenodo.4011051).

Abstract P625: Rate of Hemorrhagic Transformation After Ischemic Stroke and Associated Risk Factors: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Background: Hemorrhagic transformation (HT) of ischemic stroke can have devastating consequences, leading to longer hospitalizations, increased morbidity and mortality. We sought to identify the rate of HT in stroke patients not treated with tPA within a large, biracial population. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2015, we captured all hospitalized strokes by screening ICD-9 codes 430-436 and ICD-10 codes I60-I68, and G45-46. Study nurses abstracted all potential cases and physicians adjudicated cases, including classifying the degree of HT. Patients treated with thrombolytics were excluded. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for HT cases, age and sex adjusted to the 2000 US population. Multiple logistic regression was used to examine risk factors associated with HT. Results: In 2015, there were 2301 ischemic strokes included in the analysis. Of these 104 (4.5%) had HT; 23 (22.1%) symptomatic, 55 (52.9%) asymptomatic and 26 (25%) unknown. Documented reasons for not receiving tPA in these patients were: time (71, 68.3%), anticoagulant use (1, 1.0%), other (18,17.3%) and unknown (14, 13.5%), which were not significantly different compared to those without HT. Only 29/104 (18.3%) had HT classified as PH-1 or PH-2. The age, sex and race-adjusted rate of HT was 9.8 (7.9, 11.6) per 100,000. The table shows rates of potential risk factors and the adjusted odds of developing HT. 90 day all-cause case fatality for patients with HT was significantly higher, 27.9% vs. 15.7%, p&lt;0.0001. Conclusion: We found that 4.5% of non-tPA treated IS patients had HT. These patients had more severe strokes, were more likely to have abnormal coagulation tests or anticoagulant use, and were more likely to die within 90 days. We also report the first population-based incidence rate of HT in non-tPA treated of 9.8/100,000, a rate similar to the incidence of SAH.

Disparities in Opioid Use Disorder Treatment Admissions in the United States

ObjectivesThe Cincinnati region has been at the epicenter of the nation’s unfolding opioid epidemic. The objectives of this study were twofold: (1) to compare the Cincinnati region to the United States in length of time to obtain treatment and planned medication-assisted therapy for the treatment for opioid use disorder (OUD); and (2) to assess racial disparities within the Cincinnati region in wait time and type of treatment.MethodsThe 2017 Treatment Episode Data Set: Admissions (TEDS-A) from the Substance Abuse and Mental Health Services Administration (SAMHSA) was used to identify a cohort of eligible individuals with a primary substance use of opioids, including opioid derivatives. Logistic regression models were performed to assess the differences for treatment wait time and type of planned treatment. Model covariates included patient demographics and socioeconomic characteristics. Three different models were performed to assess the influence of covariates of the outcomes.ResultsThere were 678 766 US and 3298 Cincinnati region individuals admitted for OUD treatment in 2017. The rate per 1000 for treatment admissions was 2.08 and 1.51 (P value < 0.0001) for the United States and Cincinnati, respectively. The fully saturated regression results found that the odds of Cincinnati individuals receiving planned medication-assisted therapy were 0.497 (95% CI, 0.451–0.546; P value < 0.001). The odds of waiting longer for treatment in Cincinnati were higher than in the United States as a whole: 2.33 (95% CI, 2.19–2.48; P value < 0.001). In Cincinnati, there were 3102 Caucasian, 123 African American, and 73 Other admissions. The fully saturated model results found that Caucasians and Other had an increased likelihood of receiving planned medicationassisted therapy (OR 1.89, P value 0.039; OR 7.07, P value 0.002, respectively) compared to African Americans. Within Cincinnati, there was not a statistically significant difference in the likelihood of waiting time to receive treatment by race.ConclusionIndividuals seeking treatment for OUD in Cincinnati were less likely to receive planned medication-assisted therapy and were more likely to wait longer than individuals in the United States as a whole. These results suggest that the demand for treatment is greater than the supply in Cincinnati. Within Cincinnati, there does not appear to be a racial disparity in treatment type or length of time to receive treatment for OUD.

PMH45 DISPARITIES IN TREATMENT ADMISSIONS FOR OPIOID USE DISORDER IN CINCINNATI BY RACE

The objective of this study was to assess racial disparities within the Cincinnati region with respect to the length of time to obtain treatment, and planned medication-assisted therapy for the treatment for opioid use disorder (OUD). The Treatment Episode Data Set – Admissions from the Substance Abuse and Mental Health Administration was used to identify a cohort of eligible individuals. All 2017 admissions with a primary substance use of opioids, including opioid derivatives, were included. The data were stratified by ethnicity: Caucasian, African-American, and Other. Logistic regression models were performed to assess the differences by race for treatment wait time and type of planned treatment. Model covariates included patient demographics and socioeconomic characteristics. A total of 3,298 individuals were identified with 3,102 Caucasian, 123 African-Americans, and 73 Other. There were statistically significant differences between Caucasians, African-Americans, and Other for all patient characteristics and socio-economic factors with the exception of unemployment. The rate of treatment admissions per 1,000 for Caucasians, African-Americans, and Other was 1.71, 0.42, and 0.73, respectively. The overwhelming majority of individuals did not have planned medication assisted therapy at the time of admission (range: 73% to 89%). The percentage of individuals waiting 0-7 days for treatment was 70% for Caucasians, 89% for African-Americans, and 71% for Other. One logistic regression model found that Caucasians and Other had an increased likelihood of receiving planned medication-assisted therapy (OR 1.89, p-value 0.039; OR 7.07, p-value 0.002, respectively) compared to African-Americans. However, these results were sensitive to model specification. There was not a statistically significant difference in the likelihood of waiting time to receive treatment by race. Based on one-year of data there does not appear to be a disparity in treatment type or length of time to receive treatment for OUD in the Cincinnati region.

PMH46 GEOGRAPHIC VARIATION IN TREATMENT ADMISSIONS FOR OPIOID USE DISORDER IN CINCINNATI COMPARED TO THE UNITED STATES

The objective of this study was to compare the Cincinnati region (Cincinnati) to the United States (US) with respect to the length of time to obtain treatment, and planned medication-assisted therapy for the treatment for opioid use disorder (OUD).

Addressing the Disease Burden of Vertically Acquired Hepatitis C Virus Infection Among Opioid-Exposed Infants.

BackgroundThis study aims to estimate the disease burden of vertically acquired hepatitis C virus (HCV) in a large Midwestern hospital and to identify factors associated with HCV diagnostic testing among high-risk infants.MethodsThis is a retrospective analysis of an infant cohort (n = 58 427) born from 2014 to 2016 in the Greater Cincinnati region, where universal maternal urine testing is conducted at delivery to assess for intrauterine drug exposure (IUDE). Demographics and birth characteristics were analyzed among high-risk infants to identify factors associated with receiving HCV testing. A nested, matched, case-control analysis examined the association of pediatric HCV infection and IUDE.ResultsThe HCV prevalence rate among high-risk infants who received testing was 3.6%–5.2% of births. Approximately 66.7% of maternally acquired HCV infections may be missed using current testing recommendations. Prenatal care had no significant effect (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 0.4–3.5) on the odds of a high-risk infant receiving HCV testing. Opioid-exposed cases had a more than 6-fold increase in the odds of HCV infection (aOR, 6.2; 95% CI, 2.3–16.6]) compared with nonopioid exposed infants.ConclusionsThe IUDE was significantly associated with increased odds of pediatric HCV infection in this population. The gaps in pediatric HCV testing identified in this study, despite known risk level and maternal infection, suggest the need for increased focus on HCV identification in the pediatric population.

Estimating the Prevalence of Opioid use Disorder in the Cincinnati Region using Probabilistic Multiplier Methods and Model Averaging

Background: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. Methods: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. Results: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). Conclusions: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.

Estimating the Prevalence of Opioid use Disorder in the Cincinnati Region using Probabilistic Multiplier Methods and Model Averaging.

BackgroundOpioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region.MethodsThree individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD.ResultsThis study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population).ConclusionsThe method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.

Holistic analysis of urban water systems in the Greater Cincinnati region: (1) life cycle assessment and cost implications

Urban water and wastewater utilities are striving to improve their environmental and economic performances due to multiple challenges such as increasingly stringent quality criterion, aging infrastructure, constraining financial burden, growing urban population, climate challenges and dwindling resources. Growing needs of holistic assessments of urban water systems are required to identify systems-level cross-domain solutions. This study evaluated the life cycle environmental and economic impacts of urban water and wastewater systems with two utilities in Greater Cincinnati region as a case study. The scope of this study includes the entire urban water and wastewater systems starting from raw water acquisition for drinking water to wastewater treatment and discharge. The detailed process-based life cycle models were developed based on the datasets provided by local water and wastewater utilities. The life cycle assessment indicated that the operation and maintenance of drinking water distribution was a dominating contributor for energy consumption (43%) and global warming potential (41%). Wastewater discharge from the wastewater treatment plant contributed to more than 80% of the total eutrophication potential. The cost analysis determined that labor and maintenance cost (19%) for wastewater collection, and electricity cost (13%) for drinking water distribution were major contributors. Electricity purchased by the utility was the driver for the majority of impact categories assessed with the exception of eutrophication, blue water use, and metal depletion. Infrastructure requirements had a negligible influence on impact results, contributing less than 3% to most categories, with the exception of metal depletion where it led to 68% of total burdens. Sensitivity analysis showed that the life cycle environmental results were more sensitive to the choice of the electricity mixes and electricity consumption than the rest of input parameters such as chemical dosages, and infrastructure life time. This is one of the first comprehensive studies of the whole urban water system using real case data. It elucidates a bigger picture of energy, resource and cost distributions in a typical urban centralized water system. Inherent to a modern city as large population centers, a significant expenditure has to be invested to provide water services function (moving water, treating water/wastewater) in order to avoid human and environmental health problems. This study provides insights for optimization potentials of overall treatment efficiency and can serve as a benchmark for communities considering adoption of alternative water systems.

Patterns and correlates of urban trail use: Evidence from the Cincinnati metropolitan area

Transportation, parks, and health organizations are collaborating to develop multiuse trail networks that meet the needs of metropolitan residents for utilitarian travel, recreation, and fitness. This paper describes how trails are used and explores correlates of trail use in the Greater Cincinnati region. Drawing on a systematic survey of users, we use ordinary probit and spatial models to explore the effects of socio-demographics, trip characteristics, attitudes, and the built environment, on recreational and utilitarian use. Most (89%) respondents report using trails for recreation; just 8.8% say they use trails for utilitarian purposes. Ordinary probit models show that users reporting recreational use are significantly more likely to be female, have incomes greater than $120,000, and travel longer distances on trails, but less likely to bike or walk to access trails. Transit connectivity is negatively correlated with recreational use. Trail users reporting utilitarian purposes are disproportionately male, significantly less likely to have incomes greater than $120,000, and more likely to take short trips on trails and to access trails by cycling or walking. They say they would commute more by cycling if connectivity were improved. Spatial probit model indicates negative spatial relationships among recreational users, implying the absence of a spatially-based common culture of trail use. Trail planners in this region can use these findings to strengthen the planning and design of trail networks and to meet the needs of different users. Given the finding most trail use is for recreational purposes, additional studies of the needs of utilitarian users are warranted.

Holistic analysis of urban water systems in the Greater Cincinnati region: (2) resource use profiles by emergy accounting approach

With increasing populations, mounting environmental pressures and aging infrastructure, urban water and wastewater utilities have to make investment decisions limited by both economic and environmental constraints. The challenges facing urban water systems can no longer be sustainably solved by traditional siloed water management approaches. A central premise of contemporary urban water management paradigms is that in order for urban water systems to be more sustainable and economical, an improvement in resource use efficiency at system level must be achieved. This study provides a quantification of the total resource use of a typical urban water system exemplified in Greater Cincinnati region from raw water extraction for drinking water to wastewater treatment and discharge, providing a better understanding of resource expenditure distributions within the system and a necessary benchmark to which future system improvements can be compared. The emergy methodology was used so that the total environmental work required to produce disparate system inputs could be expressed using a common unit. The results were compared to the concurring life cycle assessment (LCA) and life cycle costing (LCC) results of the same system. Emergy results highlight drinking water treatment and drinking water distribution as two resource-intensive stages, with energy for pumping and chemicals for conditioning representing the greatest inputs to the former and energy for pumping and metals for piping representing the greatest inputs to the latter. For wastewater collection and treatment stages, aeration and sludge handling were identified as the highest emergy unit processes, mostly due to energy use. Comparison with LCA results substantiate the environmental concerns associated with energy use in the drinking water treatment and distribution stages but indicate that environmental burdens associated with infrastructure are more dependent upon upstream resource use rather than downstream environmental impact. Results from emergy, LCA and LCC point towards aeration and sludge handling as two unit processes on the wastewater side that are particularly costly and environmentally impactful. Results in total are used to suggest alternative strategies that can alleviate identified environmental burdens and economic costs.

Presence of and Change in Self-Reported Chronic Disease in White Appalachian Adults Compared to White Adults in the Greater Cincinnati Region, 2005–2013

Abstract The Appalachian region has been identified as an area with health challenges, including higher mortality, reduced health care access, and poor health outcomes. However, the literature is lacking a randomly designed population-based survey that examines health issues in this population over time. The Greater Cincinnati Community Health Survey (CHSS), a random-digit dial telephone survey, included questions about chronic disease prevalence over an eight-year period in twenty-two counties surrounding Cincinnati, Ohio. The CHSS also identified Appalachian adults using a place-based method (respondent or parent born in an Appalachian county). This paper presents the self-reported prevalence of ten chronic conditions in the white Appalachian population in the survey region compared to the non-Appalachian population: asthma, cancer, chronic lung disease, diabetes, heart trouble or angina, high blood pressure, high cholesterol or triglycerides, stroke, severe allergies, and depression. The results show a persistent pattern of Appalachian adults with poorer health than their non-Appalachian counterparts: in 2013 significantly more Appalachians than non-Appalachians reported being told they had high blood pressure, depression, asthma, diabetes, cancer, chronic lung disease, and stroke. By collecting multiple years of data, we can see trends over time. For some conditions, the self-reported disease status of Appalachian adults has improved since 2005, though the improvement was statistically significant only for high cholesterol. For asthma, cancer, chronic lung disease, diabetes, and stroke, Appalachian self-reported disease status has significantly worsened since 2005.

Abstract 139: Trends in Ischemic Stroke Subtype Over a 17-Year Period

Introduction: Overall US stroke incidence rates have declined. Prior analysis of the Cincinnati region has demonstrated more thorough diagnostic workups coinciding with decreased proportion of cryptogenic and increased proportion of cardioembolic strokes over time in those patients presenting to the ED. We now examine trends in population-based incidence rates of stroke subtypes. Methods: Within the Greater Cincinnati/Northern Kentucky catchment area of 1.3 million, all strokes were ascertained between July 1993 and June 1994 and in 1999, 2005 and 2010. Incidence rates per 100,000, age-, race- and sex-adjusted to the 2000 US population, and associated 95% confidence intervals were calculated. Changes in stroke-subtype proportions over time were examined using a general linear model. Results: There were a total of 6859 incident ischemic strokes (1709 in 1993/94, 1778 in 1999, 1681 in 2005, and 1691 in 2010; age ≥20 years), of which 1290 (18.8%) were black and 3846 (56.1%) female. The Table shows subtype-adjusted incident rates by study period. Incidence rates of both small- and large-vessel etiology showed no significant change over time. Incidence rates of both cardioembolic and other known etiology increased significantly over time, whereas incidence rates of unknown subtype decreased significantly. Conclusions: In our large, biracial population-based cohort, while overall stroke incidence rates have been stable or declining over the last 17 years, trends for individual stroke subtypes have varied. Consistent with our prior analyses, more strokes have been attributed to cardioembolic etiology, whereas strokes attributable to small-vessel and large-vessel etiology have remained stable. The increase in cardioembolic strokes may be due to age and/or prolonged cardiac monitoring. Future analysis of age-adjusted rates for atrial fibrillation over time is warranted.

Apaired neodymium and oxygen isotopic perspective on paleoceanographic changes across the Dubuque/Maquoketa contact in the Late Ordovician Laurentian seaway

The sedimentological, paleontological, and geochemical record of the Late Ordovician Laurentian epicontinental seaway shows a number of shifts that have been variously interpreted as indicating progressive cooling, episodes of upwelling, intervals of enhanced weathering, and times of organic carbon burial with seafloor anoxia, among other hypotheses. Determining the nature and cause of changes during this interval has general significance as these events are critical in understanding the evolution of the Late Ordovician ocean-climate system during the transition from a greenhouse to an icehouse world culminating in the brief end-Ordovician glacial event and mass extinction. Discriminating among alternative explanations, though, has proved difficult. The increasingly well-resolved dataset (taxonomically, spatially, and stratigraphically) of conodont oxygen isotopic measurements as well as a growing neodymium isotopic data set are providing independent constraints on temperature and circulation patterns. Both variables are invoked in many models, and these data can, thus, be used to test model predictions. In this study we show that there is no oxygen isotopic evidence for systematic cooling across the contact between the Dubuque Formation and the Maquoketa Formation in the Upper Mississippi Valley, there is neodymium isotopic evidence for expansion of waters with the signature expected of the Iapetus Ocean onto the Galena Platform, and there is a subtle, opposite neodymium isotopic shift in correlative deposits from the Cincinnati Region. From these results, we argue that sediment starvation resulting in condensed deposition is a better explanation for the formation of the phosphatic lower portions of the Maquoketa Formation than enhanced productivity driven by upwelling of cool waters sourced from the open ocean. Further, neodymium isotopes support circulation changes associated with the initiation of the Richmondian Invasive in the Cincinnati Region.

Upper Ordovician (Sandbian-Katian) sub-surface stratigraphy of the Cincinnati Region (Ohio, USA): transition into the Sebree Trough

Facies and carbon isotope analysis of a series of four drill cores from Cincinnati, Ohio provide an opportunity to assess Late Ordovician paleoenvironmental variability along the margin of the Sebree Trough, an intracratonic basin associated with Taconian far-field tectonics. The cores provide stratigraphic data for an approximately 50km long NE-SW transect that roughly parallels the margin of the trough. The cores span the upper High Bridge Group through much of the equivalents of the Lexington Formation, and in one case into the overlying Cincinnatian strata (Kope). The cores were logged at centimeter-scale for litho-, bio-, and tapho-facies.Anumber of marker beds that are present in the cores, including K-bentonites, fossil epiboles (e.g., Prasopora bryozoans), and deformed beds, have been previously documented in the central Kentucky outcrop belt.We also sampled one core for carbon isotopes as a means of providing additional constraints on correlation into the central Kentucky outcrop belt. The facies succession in the lower half of the cores matches that of the lower members of the Lexington Formation in Kentucky (Curdsville, Logana, and lower Grier members). The upper half of the cores contain a more shale-rich facies succession, recording offshore environments that were substantially deeper than those of the Lexington Platform of the central Kentucky outcrop belt. These results corroborate previous studies, which indicated that the Sebree Trough expanded during the earliest Katian. Two positive carbon isotope excursions identified from outcrops of the Logana Member and the Macedonia bed on the Lexington Platform, are clearly recognizable in the sampled Cincinnati region drill core.We believe that one or both of these excursions are equivalent to the Guttenberg carbon isotope excursion (GICE) of the upper Mississippi Valley.

Systematics and paleobiogeographic significance of the Upper Ordovician pterygometopine trilobiteAchatellaDelo, 1935

AbstractStudy of type and new material of the pterygometopineAchatellaDelo, 1935 demonstrates the presence of four species in Upper Ordovician (Katian) strata of Laurentian North America,A.achates(Billings, 1860) from the northeastern United States and the St. Lawrence lowlands of Canada,A.carleyi(Meek, 1872) from the Cincinnati region, Ohio and Kentucky,A.katharina(Bradley, 1930), from Missouri and Oklahoma, andA.clivosaLespérance and Weissenberger, 1998 from the Gaspé Peninsula, Quebec. Perhaps as many as five additional species are present in Sandbian–Katian strata of the Laurentian terranes of Scotland and Northern Ireland, although only three of these are known well enough to code for phylogenetic analysis. The oldest pterygometopines, including species ofAchatella, are known from Middle Ordovician strata of Baltica. Phylogenetic analysis supports a single migration event from Baltica from Laurentia, followed by a modest diversification in the latter region.

Abstract W P155: Racial Differences in Ischemic Stroke Subtypes: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Background: It is well known that blacks have higher stroke incidence rates than whites. It is commonly believed that whites have more cardioembolic (CE) and large vessel (LV) ischemic strokes (IS). However, using data from 1993-94, we showed that blacks have higher rates of every IS subtype. We sought to see if this pattern persisted in 2010 within a large, biracial population of 1.3 million representative of the US. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2010, we captured all hospitalized strokes by screening ICD-9 codes 430-436. We also captured out-of-hospital strokes by sampling primary care offices and nursing homes. Study nurses abstracted all potential cases. Physicians adjudicated each possible event and then further subtyped IS based on available test results using established methods. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for each subtype using first-ever IS, with weighting of out-of-hospital event sampling, then age- and sex- adjusted to the 2000 US population. Black/white risk ratios (RR) and 95% CI were also calculated. Results: In 2010 there were 2219 IS in 2116 patients, and 1693 first-ever IS. Of the 1693 incident IS, 944 (57%) were female, 346 (21%) black, with mean age 69 years. There were 285 (18%) small vessel, 465 (27%) CE, 218 (12%) LV, 107 (6%) other identified cause, and 617 (37%) undetermined. The table shows incident IS rates by subtype and the associated RR. For each subtype of IS, blacks had a higher point estimate than whites in 2010. In 2010, the RR CI’s cross 1.0 for CE and LV, thus the RR is not statistically significant. Conclusion: It is not clear if these data represent significant differences for CE and LV subtypes in 2010 or statistical variation between periods. Regardless, stroke prevention efforts for blacks should include strategies relevant to all IS subtypes, and not just those for small vessel disease.