Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol.

INTRODUCTION Optic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function. METHODS AND ANALYSIS Treatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33 000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months. ETHICS AND DISSEMINATION TONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki, local laws and ICH-GCP. TRIAL REGISTRATION NUMBER NCT01962571.

Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.

BACKGROUND AND PURPOSE Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed. METHODS Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake. RESULTS Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex. CONCLUSIONS Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.

Multiple retinal detachment surgery: A functional outcome study. The Houston Vision Assessment Test-Retina (HVAT-Retina)

Retinal detachment is a common ophthalmologic procedure, and outcome is typically measured by a single factor-improvement in visual acuity. Health related functional outcome testing, which quantifies patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. ^ A functional outcome test (the Houston Vision Assessment Test-Retina; HVAT-Retina) was developed and validated in patients with multiple retinal detachments in the same eye. The HVAT-Retina divides an estimated total impairment into subcomponents: contribution of visual disability (potentially correctable by retinal detachment surgery) and nonvisual physical disabilities (co-morbidities not affected by retinal detachment surgery. ^ Seventy-six patients participated in this prospective multicenter study. Seven patients were excluded from the analysis because they were not certain of their answers. Cronbach's alpha coefficient was 0.91 for presurgery HVAT-Retina and 0.94 post-surgery. The item-to-total correlation ranged from 0.50 to 0.88. Visual impairment score improved by 9 points from pre-surgery (p = 0.0003). Physical impairment score also improved from pre-surgery (p = 0.0002). ^ In conclusion, the results of this study demonstrate that the instrument is reliable and valid in patients presenting with recurrent retinal detachments. The HVAT-Retina is a simple instrument and does not burden the patient or the health professional in terms of time or cost. It may be self-administrated, not requiring an interviewer. Because the HVAT-Retina was designed to demonstrate outcomes perceivable by the patient, it has the potential to guide the decision making process between patient and physician. ^

From gene to protein: Investigating the disease etiology of retinitis pigmentosa

Retinitis pigmentosa (RP) is a name given to a group of inherited retinal dystrophies that lead to progressive photoreceptor degeneration, and thus, visual impairment. It is evident at both the clinical and the molecular level that these are heterogeneous disorders, with wide variation in severity, mode of inheritance, and phenotype. The genetics of RP are not simple; the disease can be inherited in dominant, recessive, X-linked, and digenic modes. Autosomal dominant RP (adRP) results from mutations in at least ten mapped loci, but there may be dozens of genetic loci where mutations can cause RP. To date, there are over a hundred genes known to cause retinal degenerative diseases, and less than half of these have been cloned (RetNet). Among the dozens of retinitis pigmentosa loci known to exist, only a few have been identified and the remainders are inferred from linkage studies. Today, the genes for seven of the twelve-adRP loci have been identified, and these are rhodopsin, peripherin/RDS, NRL, ROM1, CRX, RP13 and RP1. My research projects involved a combination of the continued search for genes involved in retinal dystrophies, as well the investigation into the role of peripherin/RDS and RP1 in the disease etiology of autosomal dominant RP. ^ Most of the mutations leading to inherited retinal disorders have been identified in predominately retina expressed genes like rhodopsin, peripherin/RDS, and RP1. Expressed sequence tags (ESTs) that were retina-specific were culled from sequence databases and, together with laboratory analysis, were analyzed as potential candidate genes for retinal dystrophies. Thirteen of the fifty-five identified retina-specific ESTs mapped to within candidate regions for inherited retinopathies. One of these is RP1L1, a homologue of RP1 and a potential cause of adRP. ^ Once a disease-associated gene has been identified, elucidating the role of that gene in the visual process is essential for understanding what happens when the process is defective as it is in adRP. My next projects involved investigating the role of a novel 5′ donor +3 splice site mutation on the mRNA of peripherin/RDS in adRP affected individuals, and comparative sequencing in RP1 to define conserved regions of the protein. Comparative sequencing is a powerful way to delineate critical regions of a sequence because different regions of a gene have different functions, and each region is subject to different levels of functional or structural constraints. Establishing a framework of conserved domains is beneficial not only for structural or functional studies, but can also aid in determining the potential effects of mutations. With the completion of sequencing of human genome, and other organisms such as Saccharomyces cerevisiae, Caenorhabditis elegans , and Drosophila, the facility of comparative sequencing will only increase in the future. Comparative sequencing has already become an established procedure for pinpointing conserved regions of a protein, and is an efficient way to target regions of a protein for experimental and/or evolutionary analysis. ^

Neurocognitive impairment in relation to glutathione S-transferase enzyme polymorphisms among medulloblastoma patients

Background. Medulloblastoma is a type of brain cancer that accounts for approximately 7-8% of all intracranial tumors and 20-30% of pediatric brain tumors. It is the most common type of malignant brain tumor in childhood. It was reported that majority of survivors with medulloblastoma have social problems, endocrine deficits, and neurological complications. Furthermore, all had significant deficits in neurocognitive functioning. Glutathione S-transferases belong to a family of isoenzymes that catalyze the glutathione conjugation of a variety of electrophilic compounds. ^ Objective. We aimed to determine whether the development of neurocognitive impairment is associated with GST polymorphisms among children and adolescents diagnosed with medulloblastoma (MB) after radiation therapy. ^ Methods. A pilot study composing of 16 children and adolescents diagnosed with MB at Texas Children's Cancer Center was conducted. The t-test was used to determine if the GST polymorphisms were related to neurocognitive impairment and logistic regression was performed to explore association between GST polymorphisms and gender, age at diagnosis, race/ethnicity, and risk group. ^ Results. An association was observed between GSTT1 polymorphism and cognitive impairment one year after radiation and GSTM1 polymorphism two years after radiation. It was observed that patients with GSTT1 null genotype have lower performance IQ (p=0.03) and full scale IQ (p=0.02) one year after radiation and patients with GSTM1 null genotype have lower verbal IQ (p=0.02) two years after radiation. Patients under age 8 have a statistically non-significant higher risk of having not null genotypes compared to those older than age 8 (OR= 7.5, 95%CI: 0.62-90.65 and OR= 2.63, 95%CI: 0.30-23.00 for GSTT1 and GSTM1 respectively). ^ Conclusion. There was a significant association between GSTT1 polymorphism and cognitive impairment one year after radiation and between GSTM1 polymorphism and cognitive impairment two years after radiation. Further large scale studies may be needed to confirm this finding and to examine the underlying mechanism of neurocognitive impairments after treatment of medulloblastoma patients.^

Using small area estimation and geographic information systems technology to target health services for the uninsured

The three articles that comprise this dissertation describe how small area estimation and geographic information systems (GIS) technologies can be integrated to provide useful information about the number of uninsured and where they are located. Comprehensive data about the numbers and characteristics of the uninsured are typically only available from surveys. Utilization and administrative data are poor proxies from which to develop this information. Those who cannot access services are unlikely to be fully captured, either by health care provider utilization data or by state and local administrative data. In the absence of direct measures, a well-developed estimation of the local uninsured count or rate can prove valuable when assessing the unmet health service needs of this population. However, the fact that these are “estimates” increases the chances that results will be rejected or, at best, treated with suspicion. The visual impact and spatial analysis capabilities afforded by geographic information systems (GIS) technology can strengthen the likelihood of acceptance of area estimates by those most likely to benefit from the information, including health planners and policy makers. ^ The first article describes how uninsured estimates are currently being performed in the Houston metropolitan region. It details the synthetic model used to calculate numbers and percentages of uninsured, and how the resulting estimates are integrated into a GIS. The second article compares the estimation method of the first article with one currently used by the Texas State Data Center to estimate numbers of uninsured for all Texas counties. Estimates are developed for census tracts in Harris County, using both models with the same data sets. The results are statistically compared. The third article describes a new, revised synthetic method that is being tested to provide uninsured estimates at sub-county levels for eight counties in the Houston metropolitan area. It is being designed to replicate the same categorical results provided by a current U.S. Census Bureau estimation method. The estimates calculated by this revised model are compared to the most recent U.S. Census Bureau estimates, using the same areas and population categories. ^

The feasibility of self-report advance directives among elderly patients with cognitive impairment

The central objective of this dissertation was to determine the feasibility of self-completed advance directives (AD) in older persons suffering from mild and moderate stages of dementia. This was accomplished by identifying differences in ability to complete AD among elderly subjects with increasing degrees of dementia and cognitive incompetence. Secondary objectives were to describe and compare advance directives completed by elders and identified proxy decision makers. Secondary objectives were accomplished by measuring the agreement between advance directives completed by proxy and elder, and comparing that agreement across groups defined by the elder's cognitive status. This cross-sectional study employed a structured interview to elicit AD, followed by a similar interview with a proxy decision maker identified by the elder. A stratified sampling scheme recruited elders with normal cognition, mild, and moderate forms of dementia using the Mini Mental-State Exam (MMSE). The Hopkins Competency Assessment Test (HCAT) was used for evaluation of competency to make medical decisions. Analysis was conducted on "between group" (non-demented $\leftrightarrow$ mild dementia $\leftrightarrow$ moderate dementia, and competent $\leftrightarrow$ incompetent) and "within group" (elder $\leftrightarrow$ family member) variation.^ The 118 elderly subjects interviewed were generally male, Caucasian, and of low socioeconomic status. Mean age was 77. Overall, elders preferred a "trial of therapy" regarding AD rather than to "always receive the therapy". No intervention was refused outright more often than it was accepted. A test-retest of elders' AD revealed stable responses. Eleven logic checks measured appropriateness of AD responses independent of preference. No difference was found in logic error rates between elders grouped by MMSE or HCAT. Agreement between proxy and elder responses showed significant dissimilarity, indicating that proxies were not making the same medical decisions as the elders.^ Conclusions based on these data are: (1) Self reporting AD is feasible among elders showing signs of cognitive impairment and they should be given all opportunities to complete advance directives, (2) variation in preferences for advance directives in cognitively impaired elders should not be assumed to be the effects of their impairment alone, (3) proxies do not appear to forego life-prolonging interventions in the face of increasing impairment in their ward, however, their advance directives choices are frequently not those of the elder they represent. ^

(Table 1) Summary of sampling points described and main petrographic, morphological and geochemical characteristics

Targeted sampling on the Dolgovskoy Mound (northern Shatsky Ridge) revealed the presence of spectacular laterally extensive and differently shaped authigenic carbonates. The sampling stations were selected based on sidescan sonar and profiler images that show patchy backscatter and irregular and discontinuous reflections in the near subsurface. The interpretation of acoustic data from the top part of the mound supports the seafloor observations and the sampling that revealed the presence of a complex subsurface plumbing system characterized by carbonates and gas. The crusts sampled consist of carbonate cemented layered hemipelagic sedimentary Unit 1 associated with several centimetres thick microbial mats. Three different carbonate morphologies were observed: (a) tabular slabs, (b) subsurface cavernous carbonates consisting of void chambers up to 20 cm**3 in size and (c) chimney and tubular conduits vertically oriented or forming a subhorizontal network in the subsurface. The methanogenic origin of the carbonates is established based on visual observations of fluids seepage structures, 13C depletion of the carbonates (d13C varying between -36.7 per mil and -27.4 per mil), and by thin carbonate layers present within the thick microbial mats. Laboratory experiments with a Hele-Shaw cell were conducted in order to simulate the gas seepage through contrasting grain size media present on the seafloor. Combined petrography, visual observations and sandbox simulations allowed a characterization of the dynamics and the structures of the plumbing system in the near subsurface. Based on sample observations and the experiments, three observed morphologies of authigenic carbonates are interpreted, respectively, as (a) Darcian porous flow through the finely laminated clayey/coccolith-rich layers, (b) gas accumulation chambers at sites where significant fluid escape was impeded by thicker clayey layers forming the laminated Unit1 and (c) focussed vertical fluid venting and subhorizontal migration of overpressured fluids released from (b). The Hele-Shaw cell experiments represent a promising tool for investigating shallow fluid flow pathways in marine systems.

Accesibilidad digital para usuarios con discapacidad visual en entornos educativos

Este artículo presenta los avances de un trabajo de tesis de Magister en Tecnología Informática Aplicada en Educación de la Facultad de Informática de la UNLP, cuyo tema es “Accesibilidad digital para usuarios con limitaciones visuales y su relación con espacios virtuales de aprendizaje". 2 Aborda el tema de accesibilidad digital desde el marco teórico seleccionado y se mencionan los ejes de análisis dentro del marco del uso de las tecnologías como herramientas que favorecen la cognición. Se enuncia la propuesta de tesis y los primeros resultados. Se realiza una primera comparación donde se discuten las ventajas y desventajas de los espacios digitales al acceder mediante los lectores de pantalla, permitiendo establecer líneas de trabajo futuro.

Stable oxygen isotopes of Globigerinoides ruber and biostratigraphic datums at ODP Site 165-1002

Ocean Drilling Program Site 1002 in the Cariaco Basin was drilled in the final two days of Leg 165 with only a short transit remaining to the final port of San Juan, Puerto Rico. Because of severe time constraints, cores from only the first of the three long replicate holes (Hole 1002C) were opened at sea for visual description, and the shipboard sampling was restricted to the biostratigraphic examination of core catchers. The limited sampling and general scarcity of biostratigraphic datums within the late Quaternary interval covered by this greatly expanded hemipelagic sequence resulted in a very poorly defined age model for Site 1002 as reported in the Leg 165 Initial Reports volume of the Proceedings of the Ocean Drilling Program. Here, we present for the first time a new integrated stratigraphy for Site 1002 based on the standard of late Quaternary oxygen-isotope variations linked to a suite of refined biostratigraphic datums. These new data show that the sediment sequence recovered by Leg 165 in the Cariaco Basin is continuous and spans the time interval from 0 to ~580 ka, with a basal age roughly twice as old as initially suspected from the tentative shipboard identification of a single biostratigraphic datum. Lithologic subunits recognized at Site 1002 are here tied into this new stratigraphic framework, and temporal variations in major sediment components are reported. The biogenic carbonate, opal, and organic carbon contents of sediments in the Cariaco Basin tend to be high during interglacials, whereas the terrigenous contents of the sediments increase during glacials. Glacioeustatic variations in sea level are likely to exert a dominant control on these first-order variations in lithology, with glacial surface productivity and the nutrient content of waters in the Cariaco Basin affected by shoaling glacial sill depths, and glacial terrigenous inputs affected by narrowing of the inner shelf and increased proximity of direct riverine sources during sea-level lowstands.

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

Homogenization of Portuguese long-term temperature data series: Lisbon, Coimbra and Porto

Three long-term temperature data series measured in Portugal were studied to detect and correct non-climatic homogeneity breaks and are now available for future studies of climate variability. Series of monthly minimum (Tmin) and maximum (Tmax) temperatures measured in the three Portuguese meteorological stations of Lisbon (from 1856 to 2008), Coimbra (from 1865 to 2005) and Porto (from 1888 to 2001) were studied to detect and correct non-climatic homogeneity breaks. These series together with monthly series of average temperature (Taver) and temperature range (DTR) derived from them were tested in order to detect homogeneity breaks, using, firstly, metadata, secondly, a visual analysis and, thirdly, four widely used homogeneity tests: von Neumann ratio test, Buishand test, standard normal homogeneity test and Pettitt test. The homogeneity tests were used in absolute (using temperature series themselves) and relative (using sea-surface temperature anomalies series obtained from HadISST2 close to the Portuguese coast or already corrected temperature series as reference series) modes. We considered the Tmin, Tmax and DTR series as most informative for the detection of homogeneity breaks due to the fact that Tmin and Tmax could respond differently to changes in position of a thermometer or other changes in the instrument's environment; Taver series have been used, mainly, as control. The homogeneity tests show strong inhomogeneity of the original data series, which could have both internal climatic and non-climatic origins. Homogeneity breaks which have been identified by the last three mentioned homogeneity tests were compared with available metadata containing data, such as instrument changes, changes in station location and environment, observing procedures, etc. Significant homogeneity breaks (significance 95% or more) that coincide with known dates of instrumental changes have been corrected using standard procedures. It was also noted that some significant homogeneity breaks, which could not be connected to the known dates of any changes in the park of instruments or stations location and environment, could be caused by large volcanic eruptions. The corrected series were again tested for homogeneity: the corrected series were considered free of non-climatic breaks when the tests of most of monthly series showed no significant (significance 95% or more) homogeneity breaks that coincide with dates of known instrument changes. Corrected series are now available in the frame of ERA-CLIM FP7 project for future studies of climate variability.

Whale sightings, group sizes and krill biomass in West Greenland in 2005

This study combined data on fin whale Balaenoptera physalus, humpback whale Megaptera novaeangliae, minke whale B. acutorostrata, and sei whale B. borealis sightings from large-scale visual aerial and ship-based surveys (248 and 157 sightings, respectively) with synoptic acoustic sampling of krill Meganyctiphanes norvegica and Thysanoessa sp. abundance in September 2005 in West Greenland to examine the relationships between whales and their prey. Krill densities were obtained by converting relationships of volume backscattering strengths at multiple frequencies to a numerical density using an estimate of krill target strength. Krill data were vertically integrated in 25 m depth bins between 0 and 300 m to obtain water column biomass (g/m**2) and translated to density surfaces using ordinary kriging. Standard regression models (Generalized Additive Modeling, GAM, and Generalized Linear Modeling, GLM) were developed to identify important explanatory variables relating the presence, absence, and density of large whales to the physical and biological environment and different survey platforms. Large baleen whales were concentrated in 3 focal areas: (1) the northern edge of Lille Hellefiske bank between 65 and 67°N, (2) north of Paamiut at 63°N, and (3) in South Greenland between 60 and 61° N. There was a bimodal pattern of mean krill density between depths, with one peak between 50 and 75 m (mean 0.75 g/m**2, SD 2.74) and another between 225 and 275 m (mean 1.2 to 1.3 g/m**2, SD 23 to 19). Water column krill biomass was 3 times higher in South Greenland than at any other site along the coast. Total depth-integrated krill biomass was 1.3 x 10**9 (CV 0.11). Models indicated the most important parameter in predicting large baleen whale presence was integrated krill abundance, although this relationship was only significant for sightings obtained on the ship survey. This suggests that a high degree of spatio-temporal synchrony in observations is necessary for quantifying predator-prey relationships. Krill biomass was most predictive of whale presence at depths >150 m, suggesting a threshold depth below which it is energetically optimal for baleen whales to forage on krill in West Greenland.