bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Prediction Models for Mortality in Ambulatory Patients With Heart Failure
Authors: Alba Ana C. , Agoritsas Thomas , Jankowski Milosz , Courvoisier Delphine , Walter Stephen D. , Guyatt Gordon H. , Ross Heather J.
Published: July 2013

Background—

Optimal management of heart failure requires accurate assessment of prognosis. Many prognostic models are available. Our objective was to identify studies that evaluate the use of risk prediction models for mortality in ambulatory patients with heart failure and describe their performance and clinical applicability.

Methods and Results—

We searched for studies in Medline, Embase, and CINAHL in May 2012. Two reviewers selected citations including patients with heart failure and reporting on model performance in derivation or validation cohorts. We abstracted data related to population, outcomes, study quality, model discrimination, and calibration. Of the 9952 studies reviewed, we included 34 studies testing 20 models. Only 5 models were validated in independent cohorts: the Heart Failure Survival Score, the Seattle Heart Failure Model, the PACE (incorporating peripheral vascular disease, age, creatinine, and ejection fraction) risk score, a model by Frankenstein et al, and the SHOCKED predictors. The Heart Failure Survival Score was validated in 8 cohorts (2240 patients), showing poor-to-modest discrimination (
c
-statistic, 0.56–0.79), being lower in more recent cohorts. The Seattle Heart Failure Model was validated in 14 cohorts (16 057 patients), describing poor-to-acceptable discrimination (0.63–0.81), remaining relatively stable over time. Both models reported adequate calibration, although overestimating survival in specific populations. The other 3 models were validated in a cohort each, reporting poor-to-modest discrimination (0.66–0.74). Among the remaining 15 models, 6 were validated by bootstrapping (
c
-statistic, 0.74–0.85); the rest were not validated.

Conclusions—

Externally validated heart failure models showed inconsistent performance. The Heart Failure Survival Score and Seattle Heart Failure Model demonstrated modest discrimination and questionable calibration. A new model derived from contemporary patient cohorts may be required for improved prognostic performance.
Predicting Clinical Outcomes After Thrombolysis Using the iScore
Authors: Saposnik Gustavo , Reeves Mathew J. , Johnston S. Claiborne , Bath Philip M.W. , Ovbiagele Bruce
Published: July 2013

Background and Purpose—

The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA).

Methods—

We applied the iScore (
www.sorcan.ca/iscore
) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4–6), and Barthel index >90 at 3 months.

Results—

Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA;
P
<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA;
P
=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30–1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45–1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death.

Conclusions—

The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
Effects of Intensive and Moderate Public Education on Knowledge of Early Stroke Symptoms Among a Japanese Population
Authors: Morimoto Akiko , Miyamatsu Naomi , Okamura Tomonori , Nakayama Hirofumi , Toyoda Kazunori , Suzuki Kazuo , Toyota Akihiro , Hata Takashi , Yamaguchi Takenori
Published: July 2013

Background and Purpose—

To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population.

Methods—

Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis.

Results—

The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (
P
=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area;
P
<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively;
P
<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07–1.71) in the intensive intervention area and 0.96 (0.74–1.24) in the moderate intervention area compared with the control area.

Conclusions—

Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke.
New Appearance of Extraischemic Microbleeds on T2*-Weighted Magnetic Resonance Imaging 24 Hours After Tissue-type Plasminogen Activator Administration
Authors: Kimura Kazumi , Aoki Junya , Shibazaki Kensaku , Saji Naoki , Uemura Junichi , Sakamoto Yuki
Published: July 2013

Background and Purpose—

It is unknown whether new-extraischemic microbleeds (new-EMBs) develop rapidly after tissue-type plasminogen activator (tPA) infusion. We hypothesized that new-EMBs may develop rapidly after tPA infusion using T2*-weighted MRI (T2*) and investigated the frequency and clinical factors associated with new-EMBs.

Methods—

Patients with acute stroke within 3 hours of onset who were treated with tissue-type plasminogen activator (tPA) were studied prospectively. T2* was performed before and 24 hours after tPA therapy. Independent clinical factors associated with new-EMBs development were examined using multivariate logistic regression analysis.

Results—

A total of 224 patients (121 men; mean age, 76.2±10.6 years) were enrolled in the present study. MBs before tPA infusion were observed in 72 (32.1%) patients. Within 24 hours after tPA infusion, 6 (2.7%) patients had symptomatic intracranial hemorrhage (extraischemic [n=4], and hemorrhagic transformation [n=2]). Follow-up T2* revealed asymptomatic new-EMBs in 11 (4.9%) patients and hemorrhagic transformation in the infarcted area in 65 (29.0%). The total and mean number of new-EMBs were 23 and 1.6±1.3, respectively. Patients with new-EMBs more frequently had symptomatic extraischemic hemorrhage than those without new-EMBs (27.3% [3/11] versus 0.5% [1/213];
P
=0.0003). However, the frequency of hemorrhagic transformation was not different between patients with and without new-EMBs (27.3% versus 29.1%;
P
=0.9999). Multivariate logistic regression demonstrated that the presence of MBs before tPA infusion was the only independent factor associated with new-EMBs (odds ratio, 10.6; 95% confidence interval, 20.68–54.279;
P
=0.0046).

Conclusions—

New-EMBs occurred rapidly after tPA infusion in 4.9% of patients. The presence of MBs before tPA therapy was associated with new-EMBs. Patients with new-EMBs are likely to have symptomatic extraischemic hemorrhage.
Cerebral Atherosclerosis Is Associated With Cystic Infarcts and Microinfarcts but Not Alzheimer Pathologic Changes
Authors: Zheng Ling , Vinters Harry V. , Mack Wendy J. , Zarow Chris , Ellis William G. , Chui Helena C.
Published: July 2013

Background and Purpose—

Some studies have reported associations between intracranial atherosclerosis and Alzheimer disease pathology. We aimed to correlate severity of cerebral atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy with neurofibrillary tangles, neuritic plaques, and cerebral infarcts.

Methods—

This autopsy study (n=163) was drawn from a longitudinal study of subcortical ischemic vascular disease, Alzheimer disease, and normal aging. Multivariable logistic regression models were used to test associations among the 3 forms of cerebrovascular disease and the presence of ischemic and neurodegenerative brain lesions. Apolipoprotein E genotype was included as a covariate in these multivariable models.

Results—

Cerebral atherosclerosis was positively associated with microinfarcts (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2–4.4) and cystic infarcts (OR, 2.0; 95% CI, 1.0–4.2) but not Alzheimer disease pathology. Arteriolosclerosis showed a positive correlation with lacunar infarcts (OR, 2.0; 95% CI, 1.0–4.2) but not Alzheimer disease pathology. Cerebral amyloid angiopathy was inversely associated with lacunar infarcts (OR, 0.6; 95% CI, 0.41–1.1), but positively associated with Braak and Braak stage (OR, 1.5; 95% CI, 1.1–2.1) and Consortium to Establish a Registry for Alzheimer Disease plaque score (OR, 1.5; 95% CI, 1.1–2.2).

Conclusions—

Microinfarcts, which have been correlated with severity of cognitive impairment, were most strongly associated with atherosclerosis. Possible pathogenetic mechanisms include artery-to-artery emboli, especially microemboli that may include atheroemboli or platelet-fibrin emboli. Arteriolosclerosis was positively, whereas cerebral amyloid angiopathy was negatively correlated with lacunar infarcts, which might prove helpful in clinical differentiation of arteriolosclerotic from cerebral amyloid angiopathy–related vascular brain injury.
Localized Increase of Chemokines in the Lumen of Human Cerebral Aneurysms
Authors: Chalouhi Nohra , Points Lauren , Pierce Gary L. , Ballas Zuhair , Jabbour Pascal , Hasan David
Published: July 2013

Background and Purpose—

Inflammation may play an important role in the formation and rupture of cerebral aneurysms. Chemokines act as chemoattractants for leukocytes directing them toward sites of tissue inflammation. The purpose of this study was to determine whether chemokines and chemoattractant cytokines were increased in the lumen of human cerebral aneurysms.

Methods—

The concentrations of chemokines and other inflammatory molecules in blood samples drawn from the lumen of human cerebral aneurysms of 16 consecutive patients (harboring 18 aneurysms) were compared with blood samples from the femoral arteries of the same patients. Three aneurysms had ruptured.

Results—

The mean plasma concentration of regulated on activation, normal T cell expressed and secreted (RANTES), monokine-induced-by-γ-interferon (MIG), interferon-γ-induced protein-10 (IP-10), eotaxin, interleukin (IL) 8, and IL17 was significantly higher in samples taken from cerebral aneurysms compared with femoral arteries. In contrast, plasma concentrations of all remaining inflammatory molecules (except IL6) that were tested did not differ between cerebral aneurysms and femoral arteries. For unruptured aneurysms, there was a significantly higher mean plasma concentration of monocyte chemoattractant protein-1 as well as RANTES, MIG, IP-10, eotaxin, IL8, and IL17 in samples obtained from cerebral aneurysms.

Conclusions—

High plasma concentrations of chemokines (monocyte chemoattractant protein-1, RANTES, MIG, IP-10, and eotaxin) and chemoattractant cytokines (IL8 and IL17) were found in the lumen of human cerebral aneurysms. These findings suggest that there may be an active recruitment of inflammatory cells into the aneurysm wall that may be exploited therapeutically.
Morphological and Functional Assessment of Carotid Plaques Have Similar Predictive Accuracy for Coronary Artery Disease
Authors: Toutouzas Konstantinos , Benetos Georgios , Drakopoulou Maria , Michelongona Archontoula , Nikolaou Charalampia , Masoura Constantina , Stathogiannis Konstantinos , Aggeli Constantina , Tsiamis Eleftherios , Siores Elias , Stefanadis Christodoulos
Published: July 2013

Background and Purpose—

Microwave radiometry allows noninvasive in vivo measuring of internal temperature of tissues reflecting inflammation. In the present study, we evaluated the predictive accuracy of this method for the diagnosis of coronary artery disease (CAD).

Methods—

Consecutive patients (n=287) scheduled for coronary angiography were included in the study. In carotid arteries of both groups, the following measurements were performed: (1) intima-media thickness (IMT
max
) and (2) temperature measurements by microwave radiometry (Δ
T
max
). C-statistic and net reclassification improvement were used to compare the prediction ability of the markers IMT
max
and Δ
T
max
for the presence of CAD and multivessel CAD.

Results—

Of 287 patients, 239 had stenoses ≥50% (CAD group), and 48 did not have significant stenoses (NO-CAD group). Δ
T
max
was an independent predictor for the presence of CAD and multivessel CAD, showing similar predictive accuracy to intima-media thickness, as assessed by c-statistic and net reclassification improvement.

Conclusions—

Local inflammatory activation, as detected by microwave radiometry, has similar predictive accuracy to intima-media thickness for the presence and extent of CAD.
Support for Traditional Female Roles across 32 Countries: Female Labour Market Participation, Policy Models and Gender Differences
Authors: André Stéfanie , André Stéfanie , Gesthuizen Maurice , André Stéfanie , Gesthuizen Maurice , Scheepers Peer
Published: July 2013

Abstract

In this research we study support for traditional female roles. We test individual and contextual explanations for differences in support for traditional female roles within and across 32 countries. Higher educated, employed people and those who do not adhere to a religion are least supportive. The higher the female labour market participation, the less traditional the average citizen is: this contextual effect is stronger for women than for men. Governmental child care expenditure does not affect average levels of support for traditional female roles. Yet, we do find a significant drop in traditional attitudes for men, when governments spend more on child care. This shows the importance of including the possibility of differences in contextual effects for men and women.
Who Joins Trade Unions? Testing New Sociological Explanations
Authors: Kollmeyer Christopher
Published: July 2013

Abstract

Why do some workers join trade unions and others do not? This article attempts to shed new light on this question by considering how certain behavioural and attitudinal differences among workers shape their propensities to join trade unions. In particular, it is hypothesized that variations in civic and political engagement, as well political and cultural values, are important but overlooked determinants of trade union membership. This hypothesis is tested with data on 12 affluent democracies from the World Value Survey. Results from binary logistic regression models indicate that individual-level variation in trade union participation positively correlates with civic and political participation, with left-leaning political views, but not with post-materialist values. The article concludes by discussing the research’s limitations and its implications for issues surrounding organized labour’s changing fortunes.
Moments of Millennium: Three Fictionalisations of Revelation 20 in Relation to Zoroastrian Eschatology
Authors: Mollett Margaret
Published: July 2013

Abstract

While the Millennium as described in Revelation 20 is the penultimate terminus in the premillennial dispensational end-time scheme, not much attention has been given by scholars or commentators to its precise nature. Scant mention is made of the nature of human life during this period. Claiming fidelity to absolute literalism, yet lavish in artistic license, three authors have recently plotted fictional accounts of what they imagine will happen after Christ returns to earth to reign for 1000 years. These novels are 1000. . .a Novel of the Millennium by Salem Kirban, Kingdom Come by LaHaye and Jerry Jenkins and Thunder in Paradise: Satan’s Last Storm by Jonathan Cash. This article seeks to draw out a correlation between these animated accounts and the text of Revelation 20, and in a step further, to examine their apparent resemblances to ancient Iranian texts in the post-exilic period.
Status Update: The Many Faces of Intertextuality in New Testament Study
Authors: McKay Niall
Published: July 2013

Abstract

In recent years the language of intertextuality has surfaced in many approaches to biblical interpretation. These approaches often rest on divergent and sometimes contradictory assumptions about the nature of texts. A survey of the use of intertextuality in New Testament Studies provides a snapshot of the battle lines which divide biblical scholarship today. As intertextuality is explored, the interpretive limits of historical, literary and ideological approaches are brought into focus. Concluding this survey, I argue that further productive interpretation will depend on an honest confrontation with the contradictory textual assumptions held within biblical scholarship and theology more generally.
Elements of Rhetoric in the Targums: Appeals to the Audience
Authors: Tsolin Dmytro V.
Published: July 2013

In previous studies of the Targums, scholars focused on problems of a textual, linguistic, and historical-critical nature, whereas their literary forms, with some exceptions, remained largely uninvestigated. Alongside literary modifications of the biblical text, the Aramaic translations reflect a special tradition of synagogical rhetoric. This article explores one of the most expressive elements of a sermon which comments on a biblical text—the appeals to the audience. Were these appeals interpolated spontaneously by the meturgemanim, or were they used systematically in translating and expositing certain passages? What do such insertions tell us about the text and the art of the meturgemanim?
Leafhoppers (Homoptera: Cicadellidae) that probe human skin: A review of the world literature and nineteen new records, from Panama
Authors: Núñez Edwin Domínguez , Aiello Annette
Published: July 2013

We review the world literature on leafhoppers (Cicadellidae) that have probed human skin, update the names presented in those published reports, and sort out which are original accounts and which are citations of previous reports (Table 1). We add 19 new records, representing five subfamilies, and at least 13 genera, all from Panama (Table 2). We speculate as to why these normally phytophagous insects sometimes probe human skin, and provide insight into the possible evolutionary consequences of this behavior.
National Moth Week - a new global citizen science project focused on moths
Authors: Moskowitz David , Haramaty Liti
Published: July 2013

National Moth Week is a global citizen science project focusing on moths. During the first National Moth Week, which took place in July 2012, people in over 300 locations worldwide observed and documented the presence of moths in various habitats. This article describes the project’s goals and the methods used to achieve those goals. A summary of outreach activities and data collection is presented.
Psychosocial Adaptation and Adherence Among Adults With CF
Authors: Findler Liora , Shalev Keren , Barak Asher
Published: July 2013

Based on Moos and Holahan’s “Coping With Chronic Illness and Disability” model, we examined the contribution of medical impairment, illness perception, sense of coherence (SOC), relationship with the professional team, and adherence to treatment to the psychosocial adaptation (social adjustment and life satisfaction) of young adults with cystic fibrosis (CF). We also examined adherence, an important goal in and of itself for patients with CF. Seventy-one participants completed the following questionnaires: Social Adjustment, Life Satisfaction, Perceived Illness Severity, SOC, Relationship With Team, and Compliance. The legal criteria for medical impairment were also examined. Findings indicate that female patients and patients with high SOC reported better psychosocial adaptation. Participants with more severe medical impairments reported higher levels of adherence, and those who perceived their illness to be less severe reported lower levels of adherence and greater satisfaction in life. Relationship with the team was found to contribute to social adjustment. Psychosocial adaptation is associated with internal and external resources, but not necessarily with adherence to treatment. The rehabilitation counselor’s role is, therefore, to help adults with CF bridge between the contrasting dimensions of their lives, namely adherence to strict treatment protocols and psychosocial adaptation.
Development and validation methodology of the Nuss procedure surgical planner
Authors: Rechowicz Krzysztof J , McKenzie Frederic D
Published: July 2013

Surgical planners are used to achieve the optimal outcome for surgery. They are especially desired in procedures where a positive aesthetic outcome is the primary goal, such as the Nuss procedure which is a minimally invasive surgery for correcting pectus excavatum (PE) – a congenital chest wall deformity which is characterized by a deep depression of the sternum. The Nuss procedure consists of placement of a metal bar(s) underneath the sternum, thereby forcibly changing the geometry of the ribcage. Because of the prevalence of PE and the popularity of the Nuss procedure, the demand to perform this surgery is greater than ever. Therefore, a Nuss procedure surgical planner is an invaluable planning tool ensuring an optimal physiological and aesthetic outcome. We propose the development and validation of the Nuss procedure planner. First, a generic model of the ribcage is developed. Then, the computed tomography (CT) data collected from actual patients with PE is used to create a set of patient-specific finite element models (FEM). Based on finite element analyses (FEA) a force–displacement data set is created. This data is used to train an artificial neural network (ANN) to generalize the data set. In order to evaluate the planning process, a methodology which uses an average shape of the chest for comparison with results of the Nuss procedure planner is developed. Haptic feedback and inertial tracking is also implemented. The results show that it is possible to utilize this approximation of the force–displacement model for a Nuss procedure planner and trainer.
Labour flexibility and innovation, complementary or concurrent strategies? A review of the literature
Authors: De Spiegelaere Stan , Van Gyes Guy , Van Hootegem Geert
Published: July 2013

The European strategy for growth has a twofold aim: to become an innovative union and to enhance labour flexibility. Yet, few have addressed the question of whether these two strategies are compatible or concurrent. Through a review of the literature, this article addresses this question by focusing on different types of labour flexibility (functional, contractual and financial), and two types of innovation outcomes: employee-driven innovation (EDI) and organizational innovativeness. Using insights from different research traditions, sound evidence is found for a positive relation between different forms of functional flexibility and both EDI and organizational innovation. This is nevertheless not so for contractual and financial flexibility. Indications are found that these types of labour flexibility are potentially negative for both EDI and organizational innovation. Yet, trends in the European labour market and EU backed policies do not focus on enhancing functional flexibility, but rather aim to increase contractual and financial flexibility.
Multicultural families: Deracializing transracial adoption
Authors: Ali Suki
Published: July 2013

In 2010, the Coalition government announced its plans for adoption reform which included ‘removing barriers’ to transracial adoption. The government has blamed social workers’ looking for ‘perfect ethnic matches’ for denying black and minority ethnic children placements with ‘loving and stable families’. The paper draws upon qualitative research with professionals and parents, which shows that the government has failed to take into account the complex ways in which race and ethnicity matter within adoption. Their wish to deracialize transracial adoption fits with wider concerns about race mixing, families and national belonging in multicultural Britain. While they attempt to minimize the importance of race and ethnicity, they continue to place race at the heart of these debates.
A Training Program to Improve IFSP/IEP Goals and Objectives Through the Routines-Based Interview
Authors: Boavida Tânia , Aguiar Cecília , McWilliam R. A.
Published: July 2013

The authors describe a training program designed to improve the knowledge and skills of early childhood interventionists. Within the context of using the Routines-Based Early Intervention approach, this training focused on improving the quality of goals and objectives on individualized plans, through the Routines-Based Interview. We structured the training around five face-to-face sessions and a follow-up 3 months later. Here, we describe the development of the program, its content and methods, and the results on improvement of the goals and objectives with 80 professionals. These participants had completed the training, provided pretraining data, and provided posttraining data. Results showed that the training described here had the desired very large effect: Quality ratings of goals and objectives increased by over three standard deviations.
Medical Therapy v. PCI in Stable Coronary Artery Disease
Authors: Wijeysundera Harindra C. , Tomlinson George , Ko Dennis T. , Dzavik Vladimir , Krahn Murray D.
Published: July 2013

Background. Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events. Objective. Cost utility analysis of initial medical therapy v. PCI with either BMS or DES. Design. Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative. Target Population. Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES. Outcome Measures. Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding. Conclusions. In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.
Health Status Utilities in Pediatrics
Authors: van Litsenburg Raphaële R. L. , Kunst Annemieke , Huisman Jaap , Ket Johannes C. F. , Kaspers Gertjan J. L. , Gemke Reinoud J. B. J.
Published: July 2013

Background. Measuring utilities and health-related quality of life (HRQL) in children is challenging due to their cognitive abilities and changing developmental stages. Purpose. To identify methodological issues on utility measurements in children, we performed a systematic review on utilities measured with a single instrument, the Health Utilities Index (HUI), in pediatric acute lymphoblastic leukemia (ALL). The secondary goal was to facilitate future cost-utility analyses without the need for time-consuming assessments. Data Sources. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched from inception to June 2012. Studies had to report on utility scores in pediatric ALL, either on or after treatment, to be included. Results. Fifteen studies were included. Most studies had methodological shortcomings, which mainly concerned study design and definition and representativeness of the study group. Utility scores were dependent on treatment variables, and there generally was an improvement in HRQL as treatment or survivorship advanced. In general, proxy-respondents were less reliable for subjective phenomena than for observable conditions. HUI2 and HUI3 scores were not interchangeable. Limitations. Studies may have been missed because no validated search method for utility studies exists, due to language bias or the exclusion of non–peer-reviewed papers. Conclusions. Most studies in this review were methodologically suboptimal. Future developments should focus on including developmentally appropriate items for the whole pediatric age group. Adding disease-specific domains may enhance the sensitivity and responsiveness of instruments. Efforts should be undertaken to elicit valuation of health states from older children and teenagers as much as possible. For now, it remains difficult to make valid and informed decisions on the financing of interventions until health state valuation in children has become more methodologically robust.
Treatment of rabbit carotid aneurysms by hybrid stents (microporous thin polyurethane-covered stents): Preservation of side-branches
Authors: Nishi Shogo , Nakayama Yasuhide , Ishibashi-Ueda Hatsue , Yoshida Masato , Yonetani Hiroshi
Published: July 2013

Objective

We sought to determine the patency of normal arterial branches from the covered segments of an artery after stenting.

Background

Most intracranial aneurysms occur at arterial branching points (bifurcations, side-branches, or perforators). The post-stenting patency of normal arterial branches from the covered segments of the artery is important. We have previously developed a hybrid stent with micropores to prevent early parent artery occlusion by more early endothelialization, and mid- to long-term parent artery stenosis by control of intimal hyperplasia after aneurysm occlusion.

Methods

We created aneurysms in 10 rabbits by distal ligation and intraluminal incubation of elastase within an endovascularly trapped proximal segment of the common carotid artery. All animals were treated with hybrid stents having micropores. Four animals were observed for one month and three each for three and 12 months. The patency of the side-branches of the subclavian artery was evaluated angiographically and in some cases, histologically.

Results

Aneurysms were completely occluded at all time points other than 12 months. The subclavian artery and brachiocephalic artery were patent, without significant stenosis. All the side-branches of the subclavian artery detected on the preoperative angiogram remained patent at the final assessment.

Conclusion

The use of hybrid stents for aneurysm repair and side-branch patency seems to be effective, as per the long-term results obtained in an animal model.
Diverging top and converging bottom: labour flexibilization and changes in career mobility in the USA
Authors: Kim Young-Mi
Published: July 2013

The purpose of this study is to explore changes in career mobility in the US labour market during the late 1990s and early 2000s, a period in which career boundaries weakened and workers’ employment options became increasingly flexible. Using multiple panel data of a nationally representative sample of US employees between 1990 and 2003, the pattern of workers’ short-term movement across various types of boundaries in the labour market is analysed, as well as change over time and by skill group. The result shows that although the probability of switching firms increased for all workers, the career trajectories of lower-skilled groups showed increasingly opposite trends from those of higher-skilled groups. In particular, occupational immobility was reduced significantly for workers in lower-skilled occupations, yet their changes of occupation occurred mainly within their origin class, resulting in strengthening of class boundaries. Implications of this finding are discussed in light of recent debate on class stratification.
Acceleration-based joint stability parameters for total knee arthroplasty that correspond with patient-reported instability
Authors: Roberts Dustyn , Khan Humera , Kim Joo H , Slover James , Walker Peter S
Published: July 2013

There is no universally accepted definition of human joint stability, particularly in nonperiodic general activities of daily living. Instability has proven to be a difficult parameter to define and quantify, since both spatial and temporal measures need to be considered to fully characterize joint stability. In this preliminary study, acceleration-based parameters were proposed to characterize the joint stability. Several time-statistical parameters of acceleration and jerk were defined as potential stability measures, since anomalous acceleration or jerk could be a symptom of poor control or stability. An inertial measurement unit attached at the level of the tibial tubercle of controls and patients following total knee arthroplasty was used to determine linear acceleration of the knee joint during several activities of daily living. The resulting accelerations and jerks were compared with patient-reported instability as determined through a standard questionnaire. Several parameters based on accelerations and jerks in the anterior/posterior direction during the step-up/step-down activity were significantly different between patients and controls and correlated with patient reports of instability in that activity. The range of the positive to negative peak acceleration and infinity norm of acceleration, in the anterior/posterior direction during the step-up/step-down activity, proved to be the best indicators of instability. As time derivatives of displacement, these acceleration-based parameters represent spatial and temporal information and are an important step forward in developing a definition and objective quantification of human joint stability that can complement the subjective patient report.
The two-edged sword: vasculitis associated with HIV and hepatitis C coinfection
Authors: Ojaimi Samar , Lin Ming-Wei , Singh Kasha P , Woolley Ian
Published: July 2013

Vasculitis has long been associated with chronic viral infections, thus the twin perils of the infection and the immune response against it that bedevils the specialties of infection and immunity. After HIV was identified, it too became associated with vasculitic syndromes. Later, hepatitis C virus was also isolated, identified and described with its own spectrum of vasculitic diseases, including hepatitis C virus-associated cryoglobulinaemia. With the increasing prevalence of HIV and hepatitis C virus coinfection, there has come an increasing recognition of the range of vasculitides that can occur in this population leading to significant morbidity, diagnostic and treatment challenges. In this review, we examine the epidemiology, pathogenesis and general principles of treatment of these systemic diseases in HIV/hepatitis C virus coinfected individuals.
Effects of rituximab-based B-cell depletion therapy on skin manifestations of lupus erythematosus – report of 17 cases and review of the literature
Authors: Hofmann SC , Leandro MJ , Morris SD , Isenberg DA
Published: July 2013

Cutaneous manifestations occur frequently in systemic lupus erythematosus (SLE) and are pathognomonic in subacute-cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Although B-cell depletion therapy (BCDT) has demonstrated efficacy in SLE with visceral involvement, its usefulness for patients with predominant skin manifestations has not been fully established. In this single-centre, retrospective study 14 consecutive SLE, one CCLE and two SCLE patients with recalcitrant skin involvement were treated with 2 × rituximab 1 g, and 1 × cyclophosphamide 750 mg.

Six months after BCDT, nine of 17 (53%) patients were in complete (CR) or partial remission (PR). Relapses occurred in 12 patients (71%) at a mean time of 10 ± 1.8 months after BCDT. A second cycle of BCDT achieved a more sustained remission in seven of nine patients (78%) lasting for a mean time of 18.4 ± 2.7 months. Minor adverse events were experienced by three patients. Mean follow-up was 30 months.

Our own results and the literature review demonstrate that BCDT based on rituximab is well tolerated and may be effective for cutaneous lesions of lupus erythematosus. Randomized controlled trials are necessary to further evaluate the value of BCDT for this group of patients.
Impaired aerobic exercise capacity and cardiac autonomic control in primary antiphospholipid syndrome
Authors: Garcia CB , Perandini LA , Seguro LPC , Gualano B , Roschel H , Bonfa E , Borba EF , Sá-Pinto AL
Published: July 2013

Primary antiphospholipid syndrome (PAPS) is associated with increased risk of cardiovascular disease and mortality. Aerobic capacity and cardiac autonomic control are also associated with these risks. The aim of our study was to assess aerobic capacity and cardiac autonomic control in PAPS patients. Thirteen women with PAPS and 13 healthy controls matched for age, gender, and body mass index were enrolled for the study. Both groups were sedentary and were not under chronotropic, antidepressants and hypolipemiant drugs. All subjects performed a treadmill-graded maximal exercise. Aerobic capacity was assessed by peak oxygen uptake (VO2peak), time at anaerobic ventilatory threshold (VAT) and respiratory compensation point (RCP) and time-to-exhaustion, whereas cardiac autonomic control was assessed by chronotropic reserve (CR) and heart rate recovery at the first and second minutes after graded exercise (HRR1min and HRR2min, respectively). All aerobic capacity indexes were reduced more in PAPS patients than in healthy subjects: VO2peak (30.2 ± 4.7 vs 34.6 ± 4.3 ml.kg−1.min−1, p = 0.021), time at VAT (3.0 ± 1.5 vs 5.0 ± 2.0 min, p = 0.016), time at RCP (6.5 ± 2.0 vs 8.0 ± 2.0 min, p = 0.050), time-to-exhaustion (8.5 ± 2.0 vs 11.0 ± 2.5 min, p = 0.010). HRR1min (22 ± 9 vs 30 ± 7 bpm, p = 0.032) and HRR2min (33 ± 9 vs 46 ± 8 bpm, p = 0.002) were delayed in PAPS patients compared to healthy controls but CR was not significantly different ( p = 0.272). In conclusion, an impaired aerobic capacity and cardiac autonomic control was identified in PAPS.
Systemic lupus erythematosus complicating autoimmune pulmonary alveolar proteinosis that was worsened by immunosuppressive therapy
Authors: Nagasawa J , Kurasawa K , Maezawa R , Owada T , Hanaoka R , Fukuda T
Published: July 2013

A 26-year-old Japanese woman developed autoimmune pulmonary alveolar proteinosis (PAP) during glucocorticoid therapy for systemic lupus erythematosus (SLE). Intensive immunosuppressive therapy worsened the PAP. De-escalation of immunosuppressive therapy improved the PAP. Autoimmune PAP is rarely associated with systemic autoimmune diseases, and the present case is the first case of autoimmune PAP associated with SLE. Moreover, the present case suggests that immunosuppressive therapy should be avoided or used carefully for the treatment of patients with anti-GM-CSF antibody, such as those with autoimmune PAP.
Education, outreach, and inclusive engagement: Towards integrated indicators of successful program outcomes in participatory science
Authors: Haywood Benjamin K. , Besley John C.
Published: July 2013

The use and utility of science in society is often influenced by the structure, legitimacy, and efficacy of the scientific research process. Public participation in scientific research (PPSR) is a growing field of practice aimed at enhancing both public knowledge and understanding of science (education outreach) and the efficacy and responsiveness of scientific research, practice, and policy (participatory engagement). However, PPSR objectives focused on “education outreach” and “participatory engagement” have each emerged from diverse theoretical traditions that maintain distinct indicators of success used for program development and evaluation. Although areas of intersection and overlap among these two traditions exist in theory and practice, a set of comprehensive standards has yet to coalesce that supports the key principles of both traditions in an assimilated fashion. To fill this void, a comprehensive indicators framework is proposed with the goal of promoting a more integrative and synergistic PPSR program development and assessment process.
Neuropsychological Findings in Pediatric Maltreatment
Authors: De Bellis Michael D. , Woolley Donald P. , Hooper Stephen R.
Published: July 2013

Maltreated ( n = 38), maltreated + posttraumatic stress disorder (PTSD; n = 60), and control youth ( n = 104) underwent comprehensive neuropsychological testing. The two maltreated groups performed significantly lower on IQ, academic achievement, and nearly all of the neurocognitive domains than controls. Maltreated + PTSD performed significantly worse than maltreated youth without PTSD on a task in the visuospatial domain that assessed higher order visuoconstructive abilities. No group differences were evident on the fine motor domain. PTSD diagnosis duration negatively correlated with the visuospatial, and dissociation negatively correlated with the attention domain. Cumulative lifetime maltreatment types experienced negatively correlated with academic achievement. Sexual abuse negatively correlated with language and memory functions after controlling for other maltreatment types. These data support the adverse effects of maltreatment on neuropsychological functions in youth and suggest that all child protective services identified youth should be comprehensively examined for the integrity of their neuropsychological functioning and academic skills, regardless of the presence or absence of mental health symptoms.
ADHD Diagnosis
Authors: Parker Ashton , Corkum Penny
Published: July 2013

Objective: The present study investigated the validity of using the Conners’ Teacher and Parent Rating Scales (CTRS/CPRS) or semistructured diagnostic interviews (Parent Interview for Child Symptoms and Teacher Telephone Interview) to predict a best-practices clinical diagnosis of ADHD. Method: A total of 279 children received a clinical diagnosis based on a best-practices comprehensive assessment (including diagnostic parent and teacher interviews, collection of historical information, rating scales, classroom observations, and a psychoeducational assessment) at a specialty ADHD Clinic in Truro, Nova Scotia, Canada. Sensitivity and specificity with clinical diagnosis were determined for the ratings scales and diagnostic interviews. Results: Sensitivity and specificity values were high for the diagnostic interviews (91.8% and 70.7%, respectively). However, while sensitivity of the CTRS/CPRS was relatively high (83.5%), specificity was poor (35.7%). Conclusion: The low specificity of the CPRS/CTRS is not sufficient to be used alone to diagnose ADHD. (J. of Att. Dis. 2016; 20(6) 478-486)
Comparison of deep gray matter lesions on magnetic resonance imaging among adults with acute disseminated encephalomyelitis, multiple sclerosis, and neuromyelitis optica
Authors: Zhang Lei , Wu Aimin , Zhang Bingjun , Chen Suqin , Men Xuejiao , Lin Yinyao , Lu Zhengqi
Published: July 2013

Background:

Deep gray matter lesions have been reported in patients with acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), and neuromyelitis optica (NMO).

Objectives:

The purpose of this study was to compare the features of deep gray matter lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, MS, and NMO.

Methods:

Ninety-five adult patients with ADEM ( n=12), MS ( n=60), and NMO ( n=23) who had deep gray matter lesions on MRI were enrolled. Morphological features of deep gray matter lesions among these patients were assessed.

Results:

Putamen involvement was more common in patients with ADEM than in patients with MS and NMO. Differing from children, thalamus involvement might not be helpful in differentiating ADEM from MS in adults. Hypothalamus involvement was more common in patients with NMO than in patients with ADEM and MS. More importantly, bilateral hypothalamus involvement was more helpful in differentiating NMO from MS. The diameter of the thalamus lesions in patients with ADEM was larger than that in patients with NMO.

Conclusions:

Morphological features of deep gray matter lesions vary among adult patients with ADEM, MS, and NMO, and may be helpful in distinguishing these diseases.
Enhancing work outcomes of employees with autism spectrum disorder through leadership: Leadership for employees with autism spectrum disorder
Authors: Parr Alissa D , Hunter Samuel T
Published: July 2013

The focus of this study was to identify leader behaviors that elicit successful engagement of employees with autism spectrum disorder, a population that is powerfully emerging into the workplace. The ultimate goal was to improve the quality of life of employees with autism spectrum disorder by facilitating an environment leading to their success. Through a series of interviews with 54 employees with autism spectrum disorder, results indicated that leadership has a great effect on employee attitudes and performance, and that the notion of leadership preferences is quite complex culminating in several important behaviors rather than one superior leadership theory. Implications and future research directions are discussed.