Learning Middle-Latitude Cyclone Formation up in the Air: Student Learning Experience, Outcomes, and Perceptions in a CAVE-Enabled Meteorology Class.

Cave Automatic Virtual Environment (CAVE) is a virtual reality (VR) environment that has not been fully studied due to its high cost and complexity in system integration. Previous CAVE-related studies mainly focused on comparing its effectiveness with other learning media, such as textbooks, desktop VR, or head-mounted display (HMD) VR. In this study, through the utilization of CAVE in a meteorology class, we concentrated on CAVE itself, measured how CAVE impacted learners' learning outcomes before and after using CAVE in an actual ongoing undergraduate-level class, and investigated how learners perceived their learning experiences. Quantitative data were collected to examine the students' knowledge acquisition and learning experience. We also triangulated the quantitative results with qualitative data from the interviews regarding learners' perceptions of the CAVE-enabled class and their knowledge mastery. The results indicated that their learning outcomes increased through learning with CAVE and that their perceptions of immersion, presence, and engagement significantly correlated with each other. The interview results showed a great fondness of and satisfaction with the learning experience, group collaboration, and effectiveness of the CAVE-enabled class from the learners. We also learned that the learners' learning experiences in CAVE could be further improved if we provided them with more learner-environment interaction, offered them a better sense of immersion, and reduced cybersickness. Implications of these findings are discussed.

Local intraarterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion: the Johns Hopkins Hospital experience.

BACKGROUND AND PURPOSE: Central retinal artery occlusion results in acute visual loss with poor spontaneous recovery. Current standard therapies do not alter the natural history of disease. Several open-label clinical studies using continuous infusion of thrombolytic agents have suggested that local intraarterial fibrinolysis (LIF) is efficacious in the treatment of central retinal artery occlusion. The aim is to compare the visual outcome in patients with acute central retinal artery occlusion of presumed thromboembolic etiology treated with LIF administered in aliquots with that of patients treated with standard therapy. METHODS: We conducted a single-center, nonrandomized interventional study of consecutive patients with acute central retinal artery occlusion from July 1999 to July 2006. RESULTS: Twenty-one patients received LIF and 21 received standard therapy. Seventy-six percent of subjects in the LIF group had a visual acuity improvement of one line or more compared with 33% in the standard therapy group (P=0.012, Fisher exact). Multivariate logistic regression controlling for gender, history of prior stroke/transient ischemic attack, and history of hypercholesterolemia showed that patients who received tissue plasminogen activator were 36 times more likely to have improvement in visual acuity (P=0.0001) after adjusting for these covariates. Post hoc analysis showed that patients who received tissue plasminogen activator were 13 times more likely to have improvement in visual acuity of 3 lines or more (P=0.03) and 4.9 times more likely to have a final visual acuity of 20/200 or better (P=0.04). Two groin hematomas were documented in the LIF group. No ischemic strokes, retinal or intracerebral hemorrhages were documented. CONCLUSIONS: LIF administered in aliquots is associated with an improvement in visual acuity compared with standard therapy and has few side effects.

Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke.

BACKGROUND AND PURPOSE: Acute vertebrobasilar ischemic stroke is often associated with high morbidity and mortality with limited therapeutic options. Endovascular treatment with thrombolysis has offered some hope for affected patients; however, overall outcomes have been less than satisfactory. In this report, we present the results of our approach in six consecutive cases of acute vertebrobasilar ischemic stroke by combined proximal vessel stent placement and thrombolysis. METHODS: Six consecutive cases were retrospectively reviewed for the clinical outcome of patients presenting to our institution with acute posterior circulation stroke who underwent cerebral revascularization including proximal arterial stent placement by using balloon-expandable coronary stents and intraarterial thrombolysis. All of these patients were initially evaluated by stroke team neurologists and imaged with MR, including diffusion-weighted imaging documenting acute posterior circulation stroke. MR angiography of the circle of Willis was also obtained. Short-term follow-up was conducted to assess National Institutes of Health stroke scores (NIHSS) and modified Rankin scores. RESULTS: In these six cases, a combined approach of proximal arterial stent placement (five cases of vertebral artery origin and one case of carotid and subclavian stent placement plus vertebral artery revascularization) and thrombolysis was performed at variable times after stroke onset (range, 30 hours to 5 days). Four of the six patients had good basilar artery recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 0-1 before tissue plasminogen activator thrombolysis and TIMI grade 2 after procedure). Four of six patients had excellent immediate recovery and were discharged to an acute rehabilitation unit or their homes with improved neurologic symptoms and functional status. Two patients died: one patient presented with coma at outset with an NIHSS of 38, and the other patient probably had reocclusion of the basilar artery within 24 hours despite initial postprocedural improvement. CONCLUSION: We demonstrate that, in the setting of acute stroke, stent placement in combination with revascularization and thrombolysis is practical and allows quick access to a clot and simultaneously increases perfusion through collaterals during the thrombolytic process. In particular, basilar thrombolysis may be facilitated by proximal vertebral stent placement as concomitant atheromatous vertebrobasilar stenosis is common.

Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion.

A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with diffusion-weighted imaging underwent language testing and perfusion-weighted imaging < 24h from onset of symptoms. Specific regions in perisylvian cortex were rated for the percentage of the region that was hypoperfused. Aphasia type was determined on the basis of speech fluency, comprehension, and repetition performance on the language tests. Association between aphasia type/language impairment and regions of hypoperfusion were identified with Fisher's exact tests. Results demonstrated that in patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasia types.

Vestibular compensation after ganglionectomy: ultrastructural study of the tangential vestibular nucleus and behavioral study of the hatchling chick.

The tangential nucleus is a major part of the avian vestibular nuclear complex, and its principal cells are structurally distinctive neurons participating in the vestibuloocular and vestibulocollic reflexes. After unilateral peripheral vestibular lesion, a behavioral recovery of function defined as vestibular compensation is observed. Because sprouting and hypertrophy of synapses have been reported in other regions of immature animals after central nervous system injury, we investigated whether this also occurs in the vestibular nuclei during compensation. To test this hypothesis, unilateral vestibular ganglionectomy was performed on 4-6-day-old hatchlings and vestibular function was tested during the next 2 months. Degeneration and evidence for regeneration of synapses were studied in the tangential nucleus at 1, 3, 7, and 56 days after surgery. Spoon endings, large vestibular terminals on the principal somata, degenerated 1-3 days after surgery. However, the small synaptic terminals showed no significant change in the percentage or number covering the soma or in mean terminal lengths in the deafferented or contralateral tangential nucleus. Furthermore, there was no evidence of neuron death in the tangential nucleus. Vestibular compensation occurred in three stages: 0-3 days, when vestibular synapses degenerated and severe behavioral deficits were seen; 4-9 days, when primary vestibular fibers degenerated centrally and marked improvement in both the static and the dynamic symptoms were observed; and 10-56 days, when changes in neuronal morphology were not detected but the dynamic symptoms gradually improved. Accordingly, after unilateral vestibular ganglionectomy, vestibular compensation proceeded without ultrastructural evidence of sprouting or hypertrophy of axosomatic synapses in the hatchling tangential nucleus. This rapid behavioral recovery of function distinguishes the vestibular system from other sensory systems, which, in general, exhibit much less robust recovery after injury to their peripheral receptors.