bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathologic and Morphometric Evaluation of the Nasal and Pulmonary Airways of Cats with Experimentally Induced Asthma
Authors: Venema Christine M. , Williams Kurt J. , Gershwin Laurel J. , Reinero Carol R. , Carey Stephan A.
Published: November 2012

Background: Allergic rhinitis frequently occurs as a comorbid condition in asthmatic people, suggesting that the upper and lower airways may be immunologically linked. Our research group has developed an experimental aeroallergen model of asthma in cats. We hypothesized that aeroallergen sensitization and challenge would induce morphologic changes in the nasal airways of cats that mimic those observed in the bronchial airways. Methods: Five mixed breed cats were sensitized to Bermuda grass allergen and then serially challenged with aerosolized Bermuda grass allergen to induce an asthmatic phenotype. Four control cats were similarly treated with saline vehicle. Nasal tissues and lungs were processed for histopathological and morphometric analyses. Results: Eosinophilic inflammation, epithelial hypertrophy and mucous cell metaplasia were observed along the pulmonary axial airway mucosa of allergen-sensitized (asthmatic) cats. Mild eosinophilic inflammation was observed in the nasal airways of asthmatic cats. This alteration was confined primarily to the anterior nasal cavity, resulting in an increase in tissue eosinophils at this site compared to controls (p < 0.05). A marked increase in tissue mast cells was observed throughout all regions of the nasal airways of asthmatic cats compared to control cats (p < 0.05). There was no difference in intraepithelial mucosubstances between the nasal airways of controls and asthmatic cats. There was no correlation between upper and lower airway eosinophils or mast cells. Conclusion: Cats with experimentally induced asthma exhibit morphologic changes in the nasal airways that are distinct from the alterations observed in the lungs. These results are similar to those observed in people with comorbid asthma and allergic rhinitis.
The DNA Methylation Inhibitor 5-Azacytidine Increases Regulatory T Cells and Alleviates Airway Inflammation in Ovalbumin-Sensitized Mice
Authors: Wu Cheng-Jang , Yang Chin-Yu , Chen Yi-Hsin , Chen Chun-Ming , Chen Li-Chen , Kuo Ming-Ling
Published: November 2012

Background: Asthma is characterized as a chronic inflammatory disorder of the airways associated with an enhanced TH2 response to inhaled allergens. CD4+ T regulatory (Treg) cells are controlled by the master transcription factor FoxP3 and strictly maintain peripheral immunotolerance. Epigenetic regulation of FoxP3 by DNA methyltransferase inhibitors, such as 5-azacytidine (Aza), can generate a steady supply of functional Treg cells. Therefore, we propose that Aza can augment Treg cells in vivo to prevent the pathogenesis of asthma. Methods: BALB/c mice were sensitized with chicken ovalbumin (OVA) and treated with different doses of Aza. Airway hyperresponsiveness to methacholine, eosinophilia in bronchoalveolar lavage fluid, circulating titers of OVA-specific IgG1 and IgE, and stimulating levels of TH2 cytokines from splenocytes were then determined. Cellular populations were examined by flow cytometry. PC61 antibody, which depletes CD25+ cells, was used to verify the role of CD25+ cells in Aza-induced tolerance. Results: Administration of Aza to OVA-sensitized mice diminished airway hyperreactivity, pulmonary eosinophilia, levels of OVA-specific IgG1 and IgE in serum, and secretion of TH2 cytokines from OVA-stimulated splenocytes in a dose-dependent manner. Percentages of CD25+ and FoxP3+ cells in the CD4+ cell population were notably increased in Aza-treated mice compared to sensitized control mice. Furthermore, the major symptoms of asthma were exacerbated by depleting CD25+ cells in Aza-treated mice. Conclusions: Aza may have applications as a novel clinical strategy to increase the production of Treg cells in order to modulate the airway inflammation associated with asthma.
100 Years of Immunotherapy: The Monaco Charter
Authors: Canonica G. Walter , Baena-Cagnani Carlos E. , Compalati Enrico , Bohle Barbara , Bonini Sergio , Bousquet Jean , Cox Linda , Fink-Wagner Antje H. , González Díaz Sandra , Jacobsen Lars , Passalacqua Giovanni , Pawankar Ruby , Vieths Stefan , Yusuf Osman , Zuberbier Torsten
Published: November 2012

Aims of the Monaco Charter: (1) to present the current evidence on the efficacy and safety of allergen-specific immunotherapy (SIT) and to address the reasons for its underuse in clinical practice; (2) to develop strategies to increase the awareness about the benefits and the hazards of SIT in allergic patients, lay public and healthcare professionals not trained in allergy, and (3) to make SIT accessible and affordable to eligible patients.
Activation of Glibenclamide-Sensitive ATP-Sensitive K
+
Channels During β-Adrenergically Induced Metabolic Stress Produces a Substrate for Atrial Tachyarrhythmia
Authors: Kim Shang-Jin , Zhang Haifei , Khaliulin Igor , Choisy Stéphanie C.M. , Bond Richard , Lin Hua , El Haou Said , Milnes James T. , Hancox Jules C. , Suleiman M. Saadeh , James Andrew F.
Published: November 2012

Background—

Cardiac ATP-sensitive K
+
channels have been suggested to contribute to the adaptive physiological response to metabolic challenge after β-adrenoceptor stimulation. However, an increased atrial K
+
-conductance might be expected to be proarrhythmic. We investigated the effect of ATP-sensitive K
+
channel blockade on the electrophysiological responses to β-adrenoceptor-induced metabolic challenge in intact atria.

Methods and Results—

Atrial electrograms were recorded from the left atrial epicardial surface of Langendorff-perfused rat hearts using a 5×5 electrode array. Atrial effective refractory period and conduction velocity were measured using an S
1
–S
2
protocol. The proportion of hearts in which atrial tachyarrhythmia was produced by burst-pacing was used as an index of atrial tachyarrhythmia-inducibility. Atrial nucleotide concentrations were measured by high performance liquid chromatography. Perfusion with ≥10
–9
mol/L of the β-adrenoceptor agonist, isoproterenol (ISO), resulted in a concentration-dependent reduction of atrial effective refractory period and conduction velocity. The ISO-induced changes produced a proarrhythmic substrate such that atrial tachyarrhythmia could be induced by burst-pacing. Atrial [ATP] was significantly reduced by ISO (10
–6
mol/L). Perfusion with either of the ATP-sensitive K
+
channel blockers, glibenclamide (10
–5
mol/L) or tolbutamide (10
–3
mol/L), in the absence of ISO had no effect on basal atrial electrophysiology. On the other hand, the proarrhythmic substrate induced by 10
–6
mol/L ISO was abolished by either of the sulfonylureas, which prevented induction of atrial tachyarrhythmia.

Conclusions—

Atrial ATP-sensitive K
+
channels activate in response to β-adrenergic metabolic stress in Langendorff-perfused rat hearts, resulting in a proarrhythmic substrate.
Predictors of Clinical Outcomes in Patients With Severe Aortic Stenosis Undergoing TAVI
Authors: Pilgrim Thomas , Kalesan Bindu , Wenaweser Peter , Huber Christoph , Stortecky Stefan , Buellesfeld Lutz , Khattab Ahmed A. , Eberle Balthasar , Gloekler Steffen , Gsponer Thomas , Meier Bernhard , Jüni Peter , Carrel Thierry , Windecker Stephan
Published: November 2012

Background—

Patients with severe aortic stenosis at increased surgical risk continue to experience compromised long-term survival despite successful transcatheter aortic valve implantation. We used time-related pathways in a multistate analysis to identify predictors of adverse long-term outcome in patients who underwent transcatheter aortic valve implantation.

Methods and Results—

In a cohort of 389 patients with a mean age of 82.4±5.8 years and a STS score of 6.8±5.3 undergoing transcatheter aortic valve implantation between 2007 and 2011, multistate analysis was used to estimate mortality and stroke taking into account intercurrent events including kidney injury and the composite of access site and bleeding complications (ABC). Transapical access emerged as a predictor of kidney injury (hazard ratio [HR], 2.12; 95% confidence interval [CI] 1.00–4.47) and ABC (HR, 1.78; 95% CI, 1.07–2.96), but had no impact on the risk of stroke or death. Body mass index ≤20 kg/m
2
increased the risk of stroke or death (HR, 2.64; 95% CI, 1.25–5.54). Age >80 years (HR, 3.15; 95% CI, 1.11–8.92), body mass index ≤20 kg/m
2
(HR, 4.11; 95% CI, 1.33–12.70), prior stroke (HR, 16.42; 95% CI, 3.63–74.21), and presence of atrial fibrillation at baseline (HR, 4.12; 95% CI, 1.87–9.97) increased the risk of stroke and death after an intercurrent event of ABC.

Conclusions—

A body mass index ≤20 kg/m
2
was identified as a primary predictor of stroke and death after transcatheter aortic valve implantation during long-term follow-up, whereas transapical access emerged as a predictor of kidney injury and ABC. Age >80 years, body mass index ≤20 kg/m
2
, prior stroke, and presence of atrial fibrillation at baseline increased the risk of stroke and death after an intercurrent event of ABC.
Stroke After Carotid Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)
Authors: Hill Michael D. , Brooks William , Mackey Ariane , Clark Wayne M. , Meschia James F. , Morrish William F. , Mohr J.P. , Rhodes J. David , Popma Jeffrey J. , Lal Brajesh K. , Longbottom Mary E. , Voeks Jenifer H. , Howard George , Brott Thomas G. ,   for the CREST Investigators
Published: November 2012

Background—

Stroke occurs more commonly after carotid artery stenting than after carotid endarterectomy. Details regarding stroke type, severity, and characteristics have not been reported previously. We describe the strokes that have occurred in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).

Methods and Results—

CREST is a randomized, open-allocation, controlled trial with blinded end-point adjudication. Stroke was a component of the primary composite outcome. Patients who received their assigned treatment within 30 days of randomization were included. Stroke was adjudicated by a panel of board-certified vascular neurologists with secondary central review of clinically obtained brain images. Stroke type, laterality, timing, and outcome were reported. A periprocedural stroke occurred among 81 of the 2502 patients randomized and among 69 of the 2272 in the present analysis. Strokes were predominantly minor (81%, n=56), ischemic (90%, n=62), in the anterior circulation (94%, n=65), and ipsilateral to the treated artery (88%, n=61). There were 7 hemorrhages, which occurred 3 to 21 days after the procedure, and 5 were fatal. Major stroke occurred in 13 (0.6%) of the 2272 patients. The estimated 4-year mortality after stroke was 21.1% compared with 11.6% for those without stroke. The adjusted risk of death at 4 years was higher after periprocedural stroke (hazard ratio, 2.78; 95% confidence interval, 1.63–4.76).

Conclusions—

Stroke, particularly severe stroke, was uncommon after carotid intervention in CREST, but stroke was associated with significant morbidity and was independently associated with a nearly 3-fold increased future mortality. The delayed timing of major and hemorrhagic stroke after revascularization suggests that these strokes may be preventable.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00004732.
Sprint Fidelis Lead Fractures in Patients With Cardiac Resynchronization Therapy Devices
Authors: Parkash Ratika , Thibault Bernard , Sterns Larry , Sapp John , Krahn Andrew , Talajic Mario , Luce Marilynn , Yetisir Elizabeth , Theoret-Patrick Patricia , Wells George , Tang Anthony
Published: November 2012

Background—

Using data from the Resynchronization/Defibrillation for Ambulatory Heart Failure (RAFT) study, we examined whether Fidelis lead failure was more common in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (ICD-CRT) than in patients with an ICD only.

Methods and Results—

All cases of patients who had a right ventricular defibrillation lead revision in the RAFT study were adjudicated for the presence of lead fracture. Criteria for fracture were at least 2 of the following: (1) Impedance rise (>50% or >500 Ω in 1 week), (2) short interval count >10 times per day or 300 times per month, or (3) inappropriate shock caused by noise, verified by stored electrogram. A total of 1798 patients were enrolled into the RAFT study, with a mean follow-up of 40±20 months. There were 818 patients (45.5%) who received a Fidelis lead at the original implantation, 405 with an ICD only and 413 with an ICD-CRT. There were 47 confirmed defibrillation lead fractures; 45 were Fidelis leads (5.5% of Fidelis leads). The overall rate of fracture in the ICD group was 3.2% compared with 7.8% in the ICD-CRT group (
P
=0.006; hazard ratio, 2.42; 95% confidence interval, 1.27–4.61). Significant correlates of lead fracture in this population were undergoing an ICD-CRT implantation and having ≥2 leads.

Conclusions—

In this analysis of the RAFT study, patients with an ICD-CRT were found to have a significantly higher fracture rate than patients with an ICD. This finding needs to be considered when these patients are assessed for possible lead revision at the time of an elective generator replacement.
Associations of Total and High-Molecular-Weight Adiponectin With All-Cause and Cardiovascular Mortality in Older Persons
Authors: Kizer Jorge R. , Benkeser David , Arnold Alice M. , Mukamal Kenneth J. , Ix Joachim H. , Zieman Susan J. , Siscovick David S. , Tracy Russell P. , Mantzoros Christos S. , deFilippi Christopher R. , Newman Anne B. , Djousse Luc
Published: November 2012

Background—

Adiponectin shows opposite associations with adverse outcomes in healthy middle-aged populations (lower risk) and cohorts with prevalent cardiovascular disease, heart failure, or advanced age (higher risk).

Methods and Results—

In a population-based study of older adults, we examined the relationships of total and high-molecular-weight adiponectin with mortality among subgroups defined by baseline cardiovascular status: No cardiovascular disease, heart failure, or atrial fibrillation (group 1); cardiovascular disease but no heart failure/atrial fibrillation (group 2); and heart failure/atrial fibrillation (group 3). We found significant differences in the associations with all-cause mortality across the groups. The association in group 1 was U-shaped; increasing levels of total adiponectin up to 12.4 mg/L were associated with lower mortality after adjustment for confounders (hazard ratio=0.81 per 1 SD [95% confidence interval, 0.65–0.95]), but above this cut point, higher levels conferred greater risk (hazard ratio=1.19 [95% confidence interval, 1.12–1.27]). Further adjustment for diabetes mellitus or insulin resistance, protection against which has been proposed to mediate the beneficial relationships of adiponectin with outcome, attenuated the association in the lower range. There was no significant association in group 2, but in group 3, total adiponectin showed a direct adjusted association. Additional adjustment for putative metabolic/inflammatory intermediates suggested a direct association for group 2, and magnified the one for group 3 (hazard ratio=1.31 [1.15–1.50]). Results were similar for high-molecular-weight adiponectin and for cardiovascular mortality.

Conclusions—

Adiponectin exhibits distinct associations with mortality in elders, which shift from U-shaped to flat to direct with greater baseline cardiovascular dysfunction but become more consistently adverse after accounting for metabolic/inflammatory factors presumed to be favorably regulated by the adipokine. These findings advance understanding of the adiponectin paradox as it relates to older adults.
A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke
Authors: Luengo-Fernandez Ramon , Gray Alastair M. , Rothwell Peter M.
Published: November 2012

Background and Purpose—

Few studies have evaluated long-term costs after stroke onset, with almost no cost data for transient ischemic attack (TIA). We studied hospital costs during the 5 years after TIA or stroke in a population-based study.

Methods—

Patients from a United Kingdom population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007. Analysis was based on follow-up until 2010. Hospital resource usage was obtained from patient hospital records and valued using 2008/2009 unit costs. Because not all patients had full 5-year follow-up, we used nonparametric censoring techniques.

Results—

Among 485 TIA and 729 stroke patients ascertained and included, mean censor-adjusted 5-year hospital costs after index stroke were $25741 (95% confidence interval, 23659–27914), with costs varying considerably by severity: $21134 after minor stroke; $33119 after moderate stroke; and $28552 after severe stroke. For the 239 surviving stroke patients who had reached final follow-up, mean costs were $24383 (95% confidence interval, 20156–28595), with more than half of costs ($12972) being incurred in the first year after the event. After index TIA, the mean censor-adjusted 5-year costs were $18091 (95% confidence interval, 15947–20258). A multivariate analysis showed that event severity, recurrent stroke, and coronary events after the index event were independent predictors of 5-year costs. Differences by stroke subtype were mostly explained by stroke severity and subsequent events.

Conclusions—

Long-term hospital costs after TIA and stroke are considerable, but they are mainly incurred during the first year after the index event. Event severity and experiencing subsequent stroke and coronary events after the index event accounted for much of the increase in costs.
Trends in Substance Abuse Preceding Stroke Among Young Adults
Authors: de los Ríos Felipe , Kleindorfer Dawn O. , Khoury Jane , Broderick Joseph P. , Moomaw Charles J. , Adeoye Opeolu , Flaherty Matthew L. , Khatri Pooja , Woo Daniel , Alwell Kathleen , Eilerman Jane , Ferioli Simona , Kissela Brett M.
Published: November 2012

Background and Purpose—

Approximately 5% of strokes occur in adults aged 18 to 44 years. Substance abuse is a prevalent risk factor for stroke in young adults. We sought to identify trends in substance abuse detection among stroke patients.

Methods—

Using a population-based design, we sought to identify all patients aged 18 to 54 years experiencing a stroke (ischemic or hemorrhagic) in the Greater Cincinnati and Northern Kentucky Study region during 1993 to 1994, 1999, and 2005. Demographic and clinical characteristics and substance use data were obtained retrospectively from chart review and adjudicated by physicians.

Results—

The number of young patients identified with a stroke increased from 1993 to 1994 (297) to 2005 (501). Blacks (61% vs 51%;
P
<0.02) and men (61% vs 47%;
P
<0.002) reported substance abuse (current smoking, alcohol, or illegal drug use) more frequently than did whites and women. Overall use of substances increased across study periods, 45% in 1993 versus 62% in 2005 (
P
=0.003). The trend was significant for illegal drug use (3.8% in 1993 vs 19.8% in 2005) and ever smoking (49% in 1993 vs 66% in 2005). Documentation of both cocaine and marijuana use increased over time. In 2005, half of young adults with a stroke were current smokers, and 1 in 5 abused illegal drugs.

Conclusions—

Substance abuse is common in young adults experiencing a stroke. The observed increase in substance abuse is contributing to the increased incidence of stroke in young adults. Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.
Reliability of Real-Time Video Smartphone for Assessing National Institutes of Health Stroke Scale Scores in Acute Stroke Patients
Authors: Demaerschalk Bart M. , Vegunta Sravanthi , Vargas Bert B. , Wu Qing , Channer Dwight D. , Hentz Joseph G.
Published: November 2012

Background and Purpose—

Telestroke reduces acute stroke care disparities between urban stroke centers and rural hospitals. Current technologies used to conduct remote patient assessments have high start-up costs, yet they cannot consistently establish quality timely connections. Smartphones can be used for high-quality video teleconferencing. They are inexpensive and ubiquitous among health care providers. We aimed to study the reliability of high-quality video teleconferencing using smartphones for conducting the National Institutes of Health Stroke Scale (NIHSS).

Methods—

Two vascular neurologists assessed 100 stroke patients with the NIHSS. The remote vascular neurologist assessed subjects using smartphone videoconferencing with the assistance of a bedside medical aide. The bedside vascular neurologist scored patients contemporaneously. Each vascular neurologist was blinded to the other’s NIHSS scores. We tested the inter-method agreement and physician satisfaction with the device.

Results—

We demonstrated high total NIHSS score correlation between the methods (
r
=0.949;
P
<0.001). The mean total NIHSS scores for bedside and remote assessments were 7.93±8.10 and 7.28±7.85, with ranges, of 0 to 35 and 0 to 37, respectively. Eight categories had high agreement: level of consciousness (questions), level of consciousness (commands), visual fields, motor left and right (arm and leg), and best language. Six categories had moderate agreement: level of consciousness (consciousness), best gaze, facial palsy, sensory, dysarthria, and extinction/inattention. Ataxia had poor agreement. There was high physician satisfaction with the smartphone.

Conclusions—

Smartphone high-quality video teleconferencing is reliable, easy to use, affordable for telestroke NIHSS administration, and has high physician satisfaction.
Risk of Intracranial Hemorrhage With Protease-Activated Receptor-1 Antagonists
Authors: Lee Meng , Saver Jeffrey L. , Hong Keun-Sik , Wu Hsiu-Chuan , Ovbiagele Bruce
Published: November 2012

Background and Purpose—

Recent clinical trial data suggest that protease-activated receptor-1 (PAR-1) antagonists may increase the risk of intracranial hemorrhage. Our objective was to investigate the qualitative and quantitative risks of intracranial hemorrhage in patients receiving PAR-1 antagonist therapy.

Methods—

Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from 1966 to May 2012, were searched to identify relevant studies. We included randomized controlled trials that included a comparison of PAR-1 antagonist with placebo and in which the total number of patients and intracranial hemorrhage events were reported separately for active treatment and control groups. Summary incidence rates, relative risks, and 95% confidence intervals (CIs) were calculated using random-effects models. Between-study heterogeneity was assessed using the
I
2
statistic.

Results—

In 9 PAR-1 antagonist trials with 42000 patients with a history of thrombotic vascular disease or acute coronary syndrome, PAR-1 antagonist treatment was associated with increased risk of intracranial hemorrhage (0.59% vs 0.30%; relative risk, 1.98; 95% CI, 1.46–2.68;
P
<0.00001; number needed to harm, 345). There was no heterogeneity across trials (
P
=0.84;
I
2
=0%), PAR-1 antagonist agent (
P
=0.52), treatment duration (
P
=0.38), or trial-qualifying event (
P
=0.59). Risk of death from any cause or a cardiovascular cause did not differ between active treatment and control groups.

Conclusion—

In a pooled analysis of data from 9 trials, PAR-1 antagonist therapy was associated with an increased risk for intracranial hemorrhage.
Lower Susceptibility to Cerebral Small Vessel Disease in Human Familial Longevity
Authors: Altmann-Schneider Irmhild , van der Grond Jeroen , Slagboom P. Eline , Westendorp Rudi G.J. , Maier Andrea B. , van Buchem Mark A. , de Craen Anton J.M.
Published: November 2012

Background and purpose—

On MRI, cerebral white matter lesions, lacunar infarcts, and cerebral microbleeds are common imaging correlates of cerebral small vessel damage in apparently healthy elderly individuals. We investigated whether middle-aged to elderly offspring of nonagenarian siblings, who are predisposed to become long-lived as well, have a lower prevalence of white matter lesions, lacunar infarcts, and cerebral microbleeds than control subjects.

Methods—

All subjects were from the Leiden Longevity Study. In this study, middle-aged to elderly offspring of nonagenarian siblings, who are predisposed to become long-lived as well, were contrasted to their spouses. Cerebral small vessel disease was assessed using 3-T MRI.

Results—

Offspring were less likely to have severe periventricular frontal caps (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1–1.1;
P
trend=0.01) and severe periventricular bands (OR, 0.4; 95% CI, 0.2–0.8;
P
trend=0.02). Moreover, offspring were less likely to have frontal (OR, 0.4; 95% CI, 0.2–0.9;
P
trend=0.05), parietal (OR, 0.4; 95% CI, 0.1–0.9;
P
trend=0.001), temporal (OR, 0.3; 95% CI, 0.1–0.8];
P
trend=0.004), and occipital subcortical white matter lesions (OR, 0.3; 95% CI, 0.1–0.6;
P
trend=0.001). Prevalence of lacunar infarcts also was lower in offspring (OR, 0.3; 95% CI, 0.1–1.1;
P
=0.07). Prevalence of microbleeds was not significantly different in offspring and control subjects.

Conclusions—

Exceptional familial longevity is associated with a lower susceptibility to white matter lesions and lacunar infarcts, but not cerebral microbleeds.
Final Infarct Volume Is a Stronger Predictor of Outcome Than Recanalization in Patients With Proximal Middle Cerebral Artery Occlusion Treated With Endovascular Therapy
Authors: Zaidi Syed F. , Aghaebrahim Amin , Urra Xabier , Jumaa Mouhammad A. , Jankowitz Brian , Hammer Maxim , Nogueira Raul , Horowitz Michael , Reddy Vivek , Jovin Tudor G.
Published: November 2012

Background and Purpose—

The rationale for recanalization therapy in acute ischemic stroke is to preserve brain through penumbral salvage and thus improve clinical outcomes. We sought to determine the relationship between recanalization, clinical outcomes, and final infarct volumes in acute ischemic stroke patients presenting with middle cerebral artery occlusion who underwent endovascular therapy and post-procedure magnetic resonance imaging.

Methods—

We identified 201 patients with middle cerebral artery occlusion. Patients with other occlusive lesions were excluded. Baseline clinical/radiological characteristics, procedural outcomes (including thrombolysis in cerebral infarction scores), clinical outcome scores (modified Rankin scores), and final infarct volumes on diffusion weighted imaging were retrospectively analyzed from a prospectively collected database. Favorable outcome is defined as 90-day modified Rankin score ≤2.

Results—

Successful recanalization (thrombolysis in cerebral infarction grade 2b or 3) was achieved in 63.2% and favorable outcomes in 46% of cases. Mean infarct volume was 50.1 mL in recanalized versus 133.9 mL in non-recanalized patients (
P
<0.01) and 40.4 mL in patients with favorable outcomes versus 111.8 in patients with unfavorable outcomes (
P
<0.01). In multivariate analysis, thrombolysis in cerebral infarction ≥2b, baseline National Institute of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography scores, and age were identified as independent predictors of outcome. However, when infarct volumes were included in the analysis only final infarct volume and age remained significantly associated.

Conclusions—

Successful recanalization leads to improved functional outcomes through a reduction in final infarct volumes. In our series, age and final infarct volume but not recanalization were found to be independent predictors of outcome, supporting the use of final infarct volume as surrogate marker of outcome in acute stroke trials.
Isolated Nondominant Right Coronary Stenosis
Authors: Ilia Reuben , Cafri Carlos , Wolak Arik , Weinstein Jean Marc
Published: November 2012

The frequency, clinical presentation, and management of severely stenotic isolated nondominant right coronary artery (NDRCA) have not been adequately defined. We sought to do so in a large cohort of patients undergoing coronary angiography. We retrospectively analyzed all patients who underwent coronary angiography in our institute between 1995 and June 2012, looking at those with a severe lesion in the NDRCA, recording demographic, clinical, and angiographic data. Of the 43 327 patients, 35 (0.08%) were found to have a severely stenotic NDRCA as a single-vessel disease. The most common indication for catheterization was acute coronary syndrome (49%). Most of the patients were managed conservatively (66%) and the entire group had a relatively benign course, with no coronary deaths. Severe stenosis of the NDRCA as isolated disease is a very rare entity, and although most commonly presenting with acute coronary syndrome, conservative management was the usual approach.
Baby Unplugged
Authors: Hutton John S.
Published: November 2012

The issue of electronic media use by young children is increasingly important in pediatrics, a major risk factor for numerous chronic conditions. Despite guidelines in place since 1999, screen time is on the rise, aided by new formats removing practically all barriers of use. Key drivers are technological allure, confusion about developmental readiness, and perception of educational value, fueled by potent marketing. This article describes the development of Baby Unplugged™, a series of children’s board books celebrating “old-school,” screen-free childhood. Written by a pediatrician who also owns a children’s bookstore, the books were inspired and informed by advocacy projects in the areas of media use and early literacy as a pediatric resident. They reinforce AAP Electronic Media Guidelines, notably discouraging screen-based media under 2 years old, largely by encouraging healthy, fun alternatives. Examples include Pets, Book, and Yard. Multi-sensorial exploration and parent-child engagement are emphasized in a non-prescriptive way, featuring gender and ethnic diversity and activities that are accessible and inexpensive. The author describes challenges faced by pediatricians providing anticipatory guidance for media use, given limited time and resources and the perception that we are out of touch. This is heightened by oft-deceptive marketing of screen-based products more likely to be perceived as “cool.” Reach Out and Read is cited as an example of a successful, “cool” intervention, though limited to select populations. Baby Unplugged™ takes advocacy to the marketplace, where the screen time battle is being lost.
Neighborhood Disadvantage and Verbal Ability as Explanations of the Black–White Difference in Adolescent Violence
Authors: McNulty Thomas L. , Bellair Paul E. , Watts Stephen J.
Published: November 2012

This article develops a multilevel model that integrates individual difference and sociological explanations of the Black–White difference in adolescent violence. Our basic premise is that low verbal ability is a criminogenic risk factor that is in part an outcome of exposure to neighborhood and family disadvantages. Analysis of the 1997 National Longitudinal Survey of Youth reveals that verbal ability has direct and indirect effects (through school achievement) on violence, provides a partial explanation for the racial disparity, and mediates the effect of socioeconomic disadvantage at the neighborhood level. Results support the view that neighborhood and family disadvantages have repercussions for the acquisition of verbal ability, which, in turn, serves as a protective factor against violence. We conclude that explanation of the race difference is best conceived as originating from the segregation of Blacks in disadvantaged contexts.
Crime and the Transition to Adulthood
Authors: Bosick Stacey J.
Published: November 2012

Recent studies of the transition to adulthood advocate taking a person-centered approach and modeling key transitional events simultaneously. This article advances this literature by focusing on precarious transitioning among at-risk youth and relating their transition experiences to criminal offending. I find evidence for three distinct “pathways” to adulthood. Those with juvenile convictions are equally likely to take one of two “precarious” routes to adulthood—an early family starter pathway or a stalled pathway. Importantly, early family starters are much less likely than stalled transitioners to offend as adults. The findings suggest the transition to adulthood represents a fork in the road for juvenile delinquents in which early family starting serves as an avenue out of continued offending.
Security at the Expense of Liberty
Authors: Pickett Justin T. , Mears Daniel P. , Stewart Eric A. , Gertz Marc
Published: November 2012

In The Culture of Control: Crime and Social Order in Contemporary Society, David Garland linked contemporary crime control policies and welfare reforms to a cultural formation that he termed the “crime complex of late modernity.” According to Garland, once established, the crime complex exerts a contemporaneous effect on public views about both criminal justice and the welfare state, increasing popular support for security measures as well as more restrictive public assistance policies. Although Garland’s thesis has featured prominently in scholarship on crime and punishment, few empirical studies have tested the specific predictions that underlie his arguments. To address this research gap, this study uses public opinion data to assess the extent to which key dimensions of the crime complex are associated with public views about criminal justice policies and welfare reforms that emphasize security and control. The results support several of the theoretical underpinnings of Garland’s thesis. The authors discuss the implications of the findings for theory, research, and policy.
Joint Utility of Event-Dependent and Environmental Crime Analysis Techniques for Violent Crime Forecasting
Authors: Caplan Joel M. , Kennedy Leslie W. , Piza Eric L.
Published: November 2012

Violent crime incidents occurring in Irvington, New Jersey, in 2007 and 2008 are used to assess the joint analytical capabilities of point pattern analysis, hotspot mapping, near-repeat analysis, and risk terrain modeling. One approach to crime analysis suggests that the best way to predict future crime occurrence is to use past behavior, such as actual incidents or collections of incidents, as indicators of future behavior. An alternative approach is to consider the environment in which crimes occur and identify features of the landscape that would be conducive to crime. Thanks to advances in geographic information system technology and federally funded (free) software applications such as CrimeStat III or the Near Repeat Calculator, these methods have recently been made more accessible to “average” users. This study explores the information products that each method offers for the purposes of place-based violent crime forecasting and resource allocation. Findings help to answer questions about where, when, and why violent crimes occur in a jurisdiction. Ways in which event-dependent and environmental crime analysis techniques can be utilized as complementary instruments in a crime analyst’s tool kit are discussed in detail.
Comparative Usability Testing of Conventional and Single Incision Laparoscopic Surgery Devices
Authors: McCrory Bernadette , Lowndes Bethany R. , LaGrange Chad A. , Miller Emily E. , Hallbeck M. Susan
Published: November 2012

Objective:

The objective was to perform competitive usability testing to assess the user experience of conventional laparoscopic and laparoendoscopic single-site surgery (LESS) devices.

Background:

Recent advancements in single-incision instrumentation have created more interest in and usage of LESS. However, neither LESS nor its novel multichannel access devices have been thoroughly studied.

Method:

Using a simulation test bed and standardized laparoscopic surgery task, the user experience of three commercially available LESS devices was compared to conventional laparoscopic ports based on time on task, errors, task success, and perceived ease of use.

Results:

There were no significant differences between devices for time on task, errors, or task success ( p > .05). For all devices, there were significantly more recoverable than unrecoverable errors, and errors occurred more frequently during the second phase of the task when the dominant hand was more active ( p < .0001). Conventional laparoscopy was rated as easier to use than were the LESS devices ( p < .01).

Conclusion:

Device performance of a basic laparoscopic task was similar in both conventional laparoscopy and LESS. Each of the LESS devices facilitated efficient and accurate aiming and grasping movements compared to conventional laparoscopy. Further investigation of human factors and ergonomics of LESS is needed to further develop, evaluate, and refine single-site surgery technologies to create a user experience equivalent to conventional laparoscopy.

Application:

Competitive usability testing of medical devices yields objective performance data that can be used to inform purchase decisions and future device design improvements.
“A Good Man Always Knows His Limitations”
Authors: Loughran Thomas A. , Paternoster Raymond , Piquero Alex R. , Fagan Jeffrey
Published: November 2012

Objectives:

This study examines the prevalence of overconfidence in the perceived risk of committing crime and whether such overconfidence is related to criminal behavior.

Methods:

Two samples were used—a sample of high school students who committed minor offenses and a sample of serious juvenile offenders most with felony arrests. Overconfidence in risk was estimated as the difference between the perceived risk of arrest for one’s self and for a generalized other. The proportion of over- and underconfident persons were estimated in both samples, while pooled and random effects logit models were used to estimate the effect of risk on both self-reported offending and arrest within the sample of serious offenders.

Results:

A large proportion of youth were found to be overconfident with respect to their perceived risk, with a higher prevalence in the conventional high school sample. Within the sample of serious juvenile offenders, being overconfident about one’s own risk was found to be related to both self-reported offending and arrest, net of a base rate measure of others’ risk.

Conclusions:

We outline a theory of the relationship between overconfidence and crime that links overconfidence with a self-attribution bias and biased updating of perceived risk with new information.
Sectional Versus Intact Evaluations of Four Versions of a Chopin Étude
Authors: Wapnick Joel , Darrow Alice-Ann
Published: November 2012

The purpose of this study was to determine how evaluations of four intact performances of a Chopin étude (Op. 25, No. 9, Butterfly), differing in quality, related to evaluations of each performance’s sections. We presented each performance as five excerpts: (a) opening phrase, (b) first half, (c) second half, (d) coda, and (e) intact. We then presented 10 of the 20 excerpts a second time to assess listener reliability. Results revealed an interaction between performer and ratings: Ratings of intact performances were significantly higher than were ratings of component sections for the two best performances. For the other two performances, however, ratings of intact excerpts were significantly lower than ratings of component sections. Nonsignificant factors were sections and listener background. Data indicate that ratings of longer sections (first and second halves) were more closely tied to intact performance ratings than were shorter sections (opening phrase and coda). Correlational data revealed that piano majors were marginally more reliable than nonpiano majors.
Beyond the ‘Exclusionary City’: North-east Migrants in Neo-liberal Delhi
Authors: McDuie-Ra Duncan
Published: November 2012

Scholars have noted the ways in which Delhi’s transformation into a global city has enclosed urban spaces excluding the urban poor, labourers and migrants. One of the neglected aspects of this focus is the way in which Delhi’s transformation has created new opportunities for migrants from north-east India. This article is an ethnographic account of migrants from the north-east in Delhi. It is argued that employment opportunities in the neo-liberal spaces of the global city are fuelling a rapid increase in migration from the north-east, the very limit of India’s geographical and cultural imaginary. Outside these spaces of economic inclusion, north-east migrants continue to live as exceptional citizens and experience racism, discrimination and violence. The experiences of north-east migrants in Delhi suggest that the exclusionary city narrative is an incomplete view of urban change in India, and reveal how neo-liberal transformation is connecting heartland cities to frontier regions in ways previously unimagined.
Tourist Behavior Intentions and the Moderator Effect of Knowledge of UNESCO World Heritage Sites
Authors: Palau-Saumell Ramon , Forgas-Coll Santiago , Sánchez-García Javier , Prats-Planagumà Lluís
Published: November 2012

This study investigates the relationship of heritage building and employee displayed emotion with tourist emotions, satisfaction and behavioral intentions, and the moderator effect of knowledge of United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage Sites (WHS). A theoretical model was constructed which was tested with a total of 883 surveys. The questionnaires focus on the Basilica of the Holy Family—La Sagrada Família—in Barcelona (Catalonia, Spain). The study of the data used structural equation models by means of a multigroup analysis. The results suggest that heritage building and employee displayed emotions influence tourist emotions, tourist emotions influence satisfaction, and satisfaction influences behavioral intentions. Furthermore, a direct effect of heritage building on behavioral intentions has been identified. In addition, it has been proved that knowledge of UNESCO WHS moderates the linkages between constructs in most of the relationships in the sample analyzed.
The Impact of the EU Emissions Trading System on Air Passenger Arrivals in the Caribbean
Authors: Blanc Élodie , Winchester Niven
Published: November 2012

We estimate the impact of additional costs imposed on airlines by the European Union (EU) Emissions Trading System (ETS) on tourist arrivals in 26 Caribbean states. At an EU emission allowance price of €10, we find that the policy will, on average, increase return airfares from Europe to the Caribbean by $17 for indirect flights and $21 for direct flights. These price changes reduce region-wide arrivals to the Caribbean from the EU by between 1.4% and 2%, and decrease total arrivals (from all regions) by less than 0.4%. The decrease in total arrivals is the largest for Martinique (1.7%), and relatively large decreases are also predicted for Antigua and Barbuda, Bonaire, Barbados, Curacao, and Suriname. We conclude that the EU ETS will have a moderate impact on visitor arrivals relative to the United Kingdom’s Air Passenger Duty (APD) and the European financial crisis.
How Do We Feel on Vacation? A Closer Look at How Emotions Change over the Course of a Trip
Authors: Nawijn Jeroen , Mitas Ondrej , Lin Yeqiang , Kerstetter Deborah
Published: November 2012

The emotions of 39 American and Dutch vacationers were investigated. Their emotions were tracked daily during their vacation using a diary. Findings indicated that fluctuations in emotions are related to length of vacation. Vacationers on an 8- to 13-day trip experienced significant changes in the balance of their emotions over the course of their trip. In general, they felt good; but this feeling began to decline at the end of the vacation. The findings demonstrate that there is no clear peak in holiday happiness, which presents challenges to tourism suppliers. Implications and suggestions for future research are discussed.
A Quantified Triple Bottom Line for Tourism
Authors: Tyrrell Timothy , Paris Cody Morris , Biaett Vernon
Published: November 2012

The tradition of tourism businesses and regional tourism industries is to measure their value to the host community by jobs, wages, and tax revenues even though every member of that community is affected on a daily basis through a broad variety of impacts. This article demonstrates a conceptual approach for measuring the relative importance of the major dimensions of community quality of life that can be influenced by the tourism industry in order to calculate an indication of overall impact on the well-being of community residents. Furthermore, we have formulated an example conjoint model that values this overall performance in monetary units. This model is successfully implemented using samples of college students and tourism industry professionals in the United States and Cyprus. A monetary version of triple bottom line impacts is calculated for the impacts of changes to a specific hypothetical tourism business. Recommendations are made for the extension and application of this approach to implementing sustainable tourism.
Comparing Regression Coefficients Between Same-sample Nested Models Using Logit and Probit
Authors: Karlson Kristian Bernt , Holm Anders , Breen Richard
Published: November 2012

Logit and probit models are widely used in empirical sociological research. However, the common practice of comparing the coefficients of a given variable across differently specified models fitted to the same sample does not warrant the same interpretation in logits and probits as in linear regression. Unlike linear models, the change in the coefficient of the variable of interest cannot be straightforwardly attributed to the inclusion of confounding variables. The reason for this is that the variance of the underlying latent variable is not identified and will differ between models. We refer to this as the problem of rescaling. We propose a solution that allows researchers to assess the influence of confounding relative to the influence of rescaling, and we develop a test to assess the statistical significance of confounding. A further problem in making comparisons is that, in most cases, the error distribution, and not just its variance, will differ across models. Monte Carlo analyses indicate that other methods that have been proposed for dealing with the rescaling problem can lead to mistaken inferences if the error distributions are very different. In contrast, in all scenarios studied, our approach performs as least as well as, and in some cases better than, others when faced with differences in the error distributions. We present an example of our method using data from the National Education Longitudinal Study.