bluuebunny/crossref_metadata_2025 huggingface dataset:
Parvovirus B19 myocarditis in children: an observational study
Authors: Vigneswaran Trisha V , Brown Julianne R , Breuer Judith , Burch Michael
Published: November 2015

Background

The advent of PCR testing for the presence of viral genomes has led to the identification of parvovirus B19 (PVB19) as a causative agent of myocarditis.

Methods

The clinical presentation, course and outcome of children with PVB19 myocarditis was ascertained through a retrospective review. The PVB19 viral genome was detected by PCR from whole blood or endomyocardial biopsy specimens in patients presenting with new onset heart failure.

Results

Seventeen patients presented at a median age of 1.3 years (range: 0.4–15.4 years) in cardiac failure with a mean fractional shortening of 15±3%. Eleven patients required mechanical ventilation and intravenous inotropes and seven required extra-corporeal mechanical oxygenation. Four of the five deaths occurred in patients who had a short prodromal illness of less than 48 hours. All patients with ST segment elevation died (n=4). All non-fulminant cases survived. Event-free survival occurred in 11/17 (65%) patients. Five (29%) patients died and one patient underwent heart transplantation. Complete recovery of cardiac function occurred within a median of 12 months (range: 1–48) in five patients. There was incomplete recovery in five patients and one patient had persistent dilated cardiomyopathy.

Conclusions

PVB19 can cause a devastating myocarditis in children. Children with fulminant myocarditis, ST segment changes or a short prodrome have the worst outcome. Transplantation may be considered, but is rarely required in the acute period if mechanical circulatory support is utilised. If the initial presentation is survived, recovery of the myocardium can occur even in those who had fulminant myocarditis.
Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports)
Authors: Mountjoy M , Junge A , Alonso J M , Clarsen B , Pluim B M , Shrier I , van den Hoogenband C , Marks S , Gerrard D , Heyns P , Kaneoka K , Dijkstra H P , Khan K M
Published: November 2015

Background

Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance.

Objective

The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters.

Methods

FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated.

Results

Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented.

Conclusion

The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention.
Use of surrogate outcomes in US FDA drug approvals, 2003–2012: a survey
Authors: Yu Tsung , Hsu Yea-Jen , Fain Kevin M , Boyd Cynthia M , Holbrook Janet T , Puhan Milo A
Published: November 2015

Objective

To evaluate, across a spectrum of diseases, how often surrogate outcomes are used as a basis for drug approvals by the US Food and Drug Administration (FDA), and whether and how the rationale for using treatment effects on surrogates as predictors of treatment effects on patient-centred outcomes is discussed.

Study design and setting

We used the Drugs@FDA website to identify drug approvals produced from 2003 to 2012 by the FDA. We focused on four diseases (chronic obstructive pulmonary disease (COPD), type 1 or 2 diabetes, glaucoma and osteoporosis) for which surrogates are commonly used in trials. We reviewed the drug labels and medical reviews to provide empirical evidence on how surrogate outcomes are handled by the FDA.

Results

Of 1043 approvals screened, 58 (6%) were for the four diseases of interest. Most drugs for COPD (7/9, 78%), diabetes (26/26, 100%) and glaucoma (9/9, 100%) were approved based on surrogates while for osteoporosis, most drugs (10/14, 71%) were also approved for patient-centred outcomes (fractures). The rationale for using surrogates was discussed in 11 of the 43 (26%) drug approvals based on surrogates. In these drug approvals, we found drug approvals for diabetes are more likely than the other examined conditions to contain a discussion of trial evidence demonstrating that treatment effects on surrogate outcomes predict treatment effects on patient-centred outcomes.

Conclusions

Our results suggest that the FDA did not use a consistent approach to address surrogates in assessing the benefits and harms of drugs for COPD, type 1 or 2 diabetes, glaucoma and osteoporosis. For evaluating new drugs, patient-centred outcomes should be chosen whenever possible. If the use of surrogate outcomes is necessary, then a consistent approach is important to review the evidence for surrogacy and consider surrogate's usage in the treatment and population under study.
Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians
Authors: Bailie Jodie , Schierhout Gill , Laycock Alison , Kelaher Margaret , Percival Nikki , O'Donoghue Lynette , McNeair Tracy , Bailie Ross
Published: November 2015

Objectives

Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access.

Design

Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded ‘sentinel sites’ that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members’ and service providers’ perceptions of chronic illness care between 2010 and 2013.

Setting

Urban, regional and remote areas of Australia that have relatively large Indigenous populations.

Participants

670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews.

Results

The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care.

Conclusions

Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies.
The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke
Authors: van Eeden M , van Heugten C , van Mastrigt G A P G , van Mierlo M , Visser-Meily J M A , Evers S M A A
Published: November 2015

Objectives

To assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL.

Design

The current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke.

Setting

Adult patients with stroke were recruited from stroke units in hospitals and followed for 1 year.

Participants

Data were collected from 395 patients with stroke.

Main outcome measures

Costs and QoL expressed in utilities.

Methods

Cost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses.

Results

The total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=−0.29). Sensitivity analyses showed robustness of results.

Conclusions

We found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects.

Trial registration number

NTR3051.
Trends from the surveillance of suicidal behaviour by the Belgian Network of Sentinel General Practices over two decades: a retrospective observational study
Authors: Boffin Nicole , Moreels Sarah , Van Casteren Viviane
Published: November 2015

Objectives

First, we describe trends in characteristics of suicidal events using new (2011–2012) and previous (1993–1995, 2000–2001 and 2007–2008) data reported by the Belgian Network of Sentinel General Practices (SGP); second, we examine patient age-related trends in on-site attendance of sentinel general practitioners (GPs) as first professional caregivers following suicidal behaviour; third, we investigate the accuracy of suicide incidence estimates derived from the SGP data.

Design

Retrospective observational study.

Setting

General practices from the nationwide representative Belgian Network of SGP.

Outcome measures

Patient gender and age, suicide methods, whether the patient was new, whether the GP was the first caregiver on-site, and the outcome of the suicidal behaviour (fatal or not) were recorded on standard registration forms. The accuracy of suicide incidence estimates was tested against suicide mortality data.

Results

Over the four time periods, 1671 suicidal events were reported: 275 suicides, 1287 suicide attempts and 109 events of suicidal behaviour of unknown outcome. In 2011–2012, sentinel GPs’ on-site attendance following the suicidal behaviour of patients <65 years had continued to decrease (from 71% in 1993–1995 to 58% in 2000–2001, 39% in 2007–2008 and 25% in 2011–2012). In 2011–2012, it had also decreased steeply in the population ≥65 years (from 70% in 1993–1995, 76% in 2000–2001 and 79% in 2007–2008 to 35% in 2011–2012). No significant differences were found between the SGP-based suicide incidence estimates for 2011–2012 and the available suicide mortality rates for people <65 and ≥65 years.

Conclusions

GPs’ on-site attendance as first professional caregivers following suicidal behaviour continues to decline since 2011–2012 also in the population ≥65 years. Unawareness of patients’ suicidal behaviour endangers both care for surviving patients and the completeness of SGP surveillance data. Yet, the incidence of suicide for 2011–2012 was estimated accurately by the SGP.
Contact with the baby following stillbirth and parental mental health and well-being: a systematic review
Authors: Hennegan Julie M , Henderson Jane , Redshaw Maggie
Published: November 2015

Objective

To collate and critically appraise extant evidence for the impact of contact with the stillborn infant on parental mental health, well-being and satisfaction.

Design

Systematic review.

Data sources

A structured systematic search was conducted in 13 databases, complemented by hand-searching.

Study eligibility criteria

English language studies providing quantitative comparison of outcomes for parents who held their baby or engaged in other memory-making activities, such as having photos and handprints, compared to those who did not, were eligible for inclusion.

Outcome measures

Primary outcomes included clinically diagnosed mental health issues, standardised assessment of mental health issues or self-reported psychological distress. Secondary outcomes included poor health, relationship difficulties and satisfaction with the decision to have contact with the baby.

Results

Two authors independently screened abstracts, selected potentially eligible studies, extracted data and evaluated the quality of included papers. 11 eligible studies, reported in 18 papers, were included. Studies were heterogeneous, precluding quantitative synthesis, thus a narrative synthesis is presented. Studies presented high risks of bias, particularly in regard to sample representativeness, and confounder identification and adjustment. Results were mixed concerning the impact of holding the stillborn baby on mental health and well-being. One study found no significant effects, and two studies reported no impact on depression. Conflicting effects were found for anxiety and post-traumatic stress. Other memory-making activities were not found to have a significant association with mental health or well-being outcomes. Across studies, mothers were satisfied with their decision to hold their baby or engage in other memory making.

Conclusions

Evidence for the impact of holding the stillborn baby on mental health and well-being is sparse, and of poor quality. High-quality research guided by a priori hypotheses, with attention to potential confounders and moderating effects, is needed to provide more rigorous evidence to guide practitioners’ and parents’ decision-making for care following stillbirth.

Review protocol number

PROSPERO CRD42014013890.
Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy
Authors: Langeslag-Smith Miriam A , Vandal Alain C , Briane Vincent , Thompson Benjamin , Anstice Nicola S
Published: November 2015

Objectives

To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand.

Design

Retrospective longitudinal study.

Methods

B4 School Checkvision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child.

Primary outcome measure

Positive predictive value of the preschool vision screening programme.

Results

Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31%, 95% CI 26% to 38%). High estimated negative predictive value (NPV=92%, 95% CI 88% to 95%) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV.

Conclusions

TheB4 School Checkgenerated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.
Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study
Authors: Sinclair Shane , McConnell Shelagh , Raffin Bouchal Shelley , Ager Naree , Booker Reanne , Enns Bert , Fung Tak
Published: November 2015

Objectives

The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers.

Setting

Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada.

Participants: Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs.

Results

Data were analysed using the qualitative approach of latent content analysis. Addressing spiritual issues was understood by patients and healthcare providers, as a core, yet under addressed, component of comprehensive care. Both sets of participants felt that addressing basic spiritual issues was the responsibility of all members of the interdisciplinary team, while recognising the need for specialised and embedded support from a spiritual care professional. While healthcare providers felt that the impact of the illness and treatment had a negative effect on patients’ spiritual well-being, patients felt the opposite. Skills, challenges, key time points and clinical indicators associated with addressing spiritual issues were identified.

Conclusions

Despite a number of conceptual and clinical challenges associated with addressing spiritual issues patients and their healthcare providers emphasised the importance of an integrated approach whereby basic spiritual issues are addressed by members of the interdisciplinary team and by an embedded spiritual care professional, who in addition also provides specialised support. The identification of clinical issues associated with addressing spiritual needs provides healthcare providers with clinical guidance on how to better integrate this aspect of care into their clinical practice, while also identifying acute incidences when a more targeted and specialised approach may be of benefit.
Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study
Authors: Anderson Andrew , Roland Martin
Published: November 2015

Objective

To determine the effect of using experienced general practitioners (GPs) to review the advice given by call handlers in NHS 111, a national service giving telephone advice to people seeking medical care.

Design

Observational study following the introduction of GPs to review call handlers’ decisions which had been made using decision support software.

Setting

NHS 111 call centre covering Cambridgeshire and Peterborough.

Intervention

When a call handler using standard NHS 111 decision support software would have advised the caller to attend the hospital accident and emergency (A&E) department, the decision was reviewed by an experienced GP.

Main outcome measures

Percentage of calls where an outcome other than A&E attendance was recommended by the GP.

Results

Of 1474 cases reviewed, the GP recommended A&E attendance in 400 cases (27.1%). In the remainder of cases, the GP recommended attendance at a primary care out-of-hours centre or minor injury unit in 665 cases (45.2%) and self-management or some alternative strategy in 409 (27.8%).

Conclusions

Fewer callers to NHS 111 would be sent to emergency departments if the decision was reviewed by an experienced GP. Telephone triage services need to consider whether using relatively unskilled call handlers supported by computer software is the most cost-effective way to handle requests for medical care.
Delayed/back up antibiotic prescriptions: what do the public think?
Authors: McNulty Cliodna A M , Lecky Donna M , Hawking Meredith K D , Quigley Anna , Butler Chris C
Published: November 2015

Objective

To describe the general public's understanding, acceptance and use of delayed antibiotics.

Design

Face to face computer-assisted survey using an Ipsos MORI Capibus survey.

Setting

Randomly selected households in England using multistage sampling.

Respondents

A representative sample of 1625 adults aged over 15 years and recruited from household visits in England, using age and gender quotas for each area.

Data collection and analysis

The survey was undertaken in January 2014. Weights based on gender, age, ethnicity, working status, social grade, housing tenure and Government Office Region corrected for selection biases, so that results are broadly representative of the population.

Main outcomes measures

Proportion of respondents; understanding the meaning of the term delayed antibiotic prescription and how the strategy is used in general practice; in favour of, or opposed to clinicians offering them a delayed antibiotic; reporting receipt, use and acceptability of delayed antibiotic prescriptions in the past year.

Results

17% reported fully understanding the meaning of delayed antibiotic prescription and strategy use in general practice;72% were unaware of the term or strategy; 36–39% were in favour of, and 28–30% opposed to clinicians offering them a delayed antibiotic for throat, urine, ear or chest infections. Half of those who were fully aware of the term and practice were in favour of delayed antibiotics. Women, and older respondents, were more strongly opposed to delayed prescribing. Only 4% of all respondents, and 15% of those prescribed an antibiotic, reported being offered a delayed antibiotic in the last year.

Conclusions

Wider understanding and acceptance of delayed prescribing may facilitate increased uptake. Further research is needed to determine why groups are so strongly in favour or opposed to delayed prescribing.
Randomised, single-masked non-inferiority trial of femtosecond laser-assisted versus manual phacoemulsification cataract surgery for adults with visually significant cataract: the FACT trial protocol
Authors: Day Alexander C , Burr Jennifer M , Bunce Catey , Doré Caroline J , Sylvestre Yvonne , Wormald Richard P L , Round Jeff , McCudden Victoria , Rubin Gary , Wilkins Mark R
Published: November 2015

Introduction

Cataract is one of the leading causes of low vision in the westernised world, and cataract surgery is one of the most commonly performed operations. Laser platforms for cataract surgery are now available, the anticipated advantages of which are broad and may include better visual outcomes through greater precision and reproducibility, and improved safety. FACT is a randomised single masked non-inferiority trial to establish whether laser-assisted cataract surgery is as good as or better than standard manual phacoemulsification.

Methods and analysis

808 patients aged 18 years and over with visually significant cataract will be randomised to manual phacoemulsification cataract surgery (standard care) or laser-assisted cataract surgery (intervention arm). Outcomes will be measured at 3 and 12 months after surgery. The primary clinical outcome is uncorrected distance visual acuity (UDVA, logMAR) at 3 months in the study eye recorded by an observer masked to the trial group. Secondary outcomes include UDVA at 12 months, corrected distance visual acuity at 3 and 12 months, complications, endothelial cell loss, patient-reported outcome measures and a health economic analysis conforming to National Institute for Health and Care Excellence standards.

Ethics and dissemination

Research Ethics Committee Approval was obtained on 6 February 2015, ref: 14/LO/1937. Current protocol: v2.0 (08/04/2015). Study findings will be published in peer-reviewed journals.

Trial registration number

ISRCTN: 77602616.
Teammate familiarity and risk of injury in emergency medical services
Authors: Patterson P Daniel , Weaver Matthew D , Landsittel Douglas P , Krackhardt David , Hostler David , Vena John E , Hughes Ashley M , Salas Eduardo , Yealy Donald M
Published: November 2015

Objective

We investigated the association between teammate familiarity and workplace injury in the emergency medical services (EMS) setting.

Methods

From January 2011 to November 2013, we abstracted a mean of 29 months of shift records and Occupational Safety Health Administration injury logs from 14 EMS organisations with 37 total bases located in four US Census regions. Total teammate familiarity was calculated for each dyad as the total number of times a clinician dyad worked together over the study period. We used negative binomial regression to examine differences in injury incidence rate ratios (IRRs) by familiarity.

Results

We analysed 715 826 shift records, representing 4197 EMS clinicians and 60 701 unique dyads. We determined the mean shifts per dyad was (5.9, SD 19.7), and quartiles of familiarity were 1 shift worked together over the study period, 2–3 shifts, 4–9 shifts and ≥10 shifts worked together. More than half of all dyads worked one shift together (53.9%, n=32 739), 24.8% of dyads 2–3 shifts, 11.8% worked 4–9 shifts and 9.6% worked ≥10 shifts. The overall incidence rate of injury across all organisations was 17.5 per 100 full-time equivalent (FTE), range 4.7–85.6 per 100 FTE. The raw injury rate was 33.5 per 100 FTEs for dyads with one shift of total familiarity, 14.2 for 2–3 shifts, 8.3 for 4–9 shifts and 0.3 for ≥10 shifts. Negative binomial regression confirmed that dyads with ≥10 shifts had the lowest incidence of injury (IRR 0.03; 95% CI 0.02 to 0.04).

Conclusions

Familiarity between teammates varies in the EMS setting, and less familiarity is associated with greater incidence of workplace injury.
Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis
Authors: Che Nanying , Qu Yang , Zhang Chen , Zhang Li , Zhang Haiqing
Published: November 2015

Background

A pathological examination plays an important role in the confirmation of a diagnosis of tuberculosis, especially for smear- and culture-negative cases. However, conventional Ziehl–Neelsen staining and histological tests lack sensitivity and specificity.

Objective

To evaluate the diagnostic value of immunohistochemical staining to detectMycobacterium tuberculosisprotein Ag85B and a newly developed double staining (ZC staining) method that can simultaneously detect acid-fast bacilli andM. tuberculosisantigen in the same histological section.

Methods

A total of 282 formalin-fixed paraffin-embedded lung tissues were identified following histological examination, including 212 cases of pulmonary tuberculosis and 70 other pulmonary diseases. Ziehl–Neelsen staining, Ag85B-immunohistochemistry and the newly developed ZC staining were performed on serial sections of all the specimens.

Results

Expression patterns of Ag85B were consistent with the distribution patterns of acid-fast bacilli. The signal produced by Ag85B-immunohistochemistry was much stronger than that produced by Ziehl–Neelsen staining. The sensitivity of Ag85B-immunohistochemistry was significantly higher than that of Ziehl–Neelsen staining, 53.8% (95% CI 47.0% to 60.5%) vs 34.4% (95% CI 28.0% to 40.9%). The newly developed ZC staining, integrating advantages of both Ziehl–Neelsen staining and immunohistochemistry, further improved the rate of sensitivity up to 65.6% (95% CI 59.1% to 72.0%).

Conclusions

This new method, detecting both acid-fast bacilli andM. tuberculosisantigen, is a simple and sensitive method for the pathological diagnosis of tuberculosis and can be easily incorporated into routine tests of pathological laboratories.
Anesthetic variation and potential impact of anesthetics used during endovascular management of acute ischemic stroke
Authors: Sivasankar Chitra , Stiefel Michael , Miano Todd A , Kositratna Guy , Yandrawatthana Sukanya , Hurst Robert , Kofke W Andrew
Published: November 2015

Background

Many authors have reported that general anesthesia (GA), as a generic and uncharacterized therapy, is contraindicated for patients undergoing endovascular management of acute ischemic stroke (EMAIS). The recent American Heart Association update cautiously suggests that it might be reasonable to favor conscious sedation over GA during EMAIS. We are concerned that such recommendations will result in patients undergoing endovascular treatment without consideration of the effects of specific anesthetic agents and anesthetic dose, and without appropriate critical consideration of the individual patient's issues. We hypothesized that significant variation in anesthetic practice comprises GA, and that outcome differences among types of GA would arise.

Methods

With IRB approval, we examined the records of patients who underwent anterior circulation EMAIS at the University of Pennsylvania from 2010 to 2015. Patients were managed by different anesthesiologists with no specific protocol. We analyzed American Society of Anesthesiologists status, NIH Stroke Scale, type of stroke, procedure, different types of anesthetic, blood pressure control, and outcome metrics. Modified Rankin Scale (mRS) scores were determined from medical records.

Results

GA was used in 91% of patients. Several types of GA were employed: intravenous, volatile, and intravenous/volatile combined. mRS scores ≤2 at discharge were observed in 42.8% of patients receiving volatile anesthesia and were better in patients receiving only volatile agents after induction of anesthesia (p<0.05).

Conclusions

Our data support the notion that anesthetic techniques and associated physiology used in EMAIS are not homogeneous, making any statements about the effects of generic GA in stroke ambiguous. Moreover, our data suggest that the type of GA may affect the outcome after EMAIS.
Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms
Authors: Liang Xiao-dong , Wang Zi-liang , Li Tian-xiao , He Ying-kun , Bai Wei-xing , Wang Yang-yang , Zhou Guo-yu
Published: November 2015

Background

Coil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.

Objective

To determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.

Methods

Tirofiban was administered as an intravenous bolus (8.0 μg/kg over 3 min) followed by a maintenance infusion (0.10 μg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.

Results

Tirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.

Conclusions

Tirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.
Tocilizumab is effective against polymyalgia rheumatica: experience in 13 intractable cases
Authors: Izumi Keisuke , Kuda Harumi , Ushikubo Mari , Kuwana Masataka , Takeuchi Tsutomu , Oshima Hisaji
Published: November 2015

Polymyalgia rheumatica (PMR) affects older people, and although glucocorticoids are effective in treating PMR, they frequently result in side effects. Therefore, we conducted a retrospective study to assess the effectiveness and safety of tocilizumab as an alternative to glucocorticoids. We included 13 consecutive patients with PMR (11 women and 2 men; median age, 74 years) diagnosed according to Bird's criteria and the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria. All patients received tocilizumab infusion (8 mg/kg every 4 weeks) at our institutions, between 2008 and 2014, because of PMR relapses (n=12) or insufficient response to initial prednisolone treatment (n=1), without increasing prednisolone dosage. Seven patients were on methotrexate, and all had one or more glucocorticoid-related comorbidities. Administration of tocilizumab significantly improved inflammation and PMR symptoms such as morning stiffness, as well as the Patient-Pain and Patient-Global Assessment visual analogue scales (p<0.05). Proximal muscle pain disappeared within 8 weeks, on average, and the Health Assessment Questionnaire-Disability Index scores (p=0.098) and concomitant prednisolone doses (p<0.05) decreased at 12 weeks. Severe adverse events were not observed during the mean tocilizumab treatment period of 43.4 weeks. Our findings suggest that tocilizumab is effective and safe for PMR treatment.
Legitimacy of European Citizenship
Authors: Gerhards Jürgen , Lengfeld Holger , Schubert Sophia
Published: November 2015

eucitizens living in aneumember state of which they are not nationals may participate in local elections. Based on a survey conducted in three member states of theeuwe analyze the legitimacy of this core element of European citizenship. Firstly, we examine the extent to which European citizens support the Europeanisation of local voting rights. The results show that about two-thirds of citizens accept these rights. Secondly, we analyze whether those who reject the idea of equality for all Europeans can be determined by social characteristics. Our analyses show that opponents are not at all determined by socio-structural factors and are barely determined by cultural factors and hence do not form the basis for a politically mobilized cleavage. All in all, the results indicate that citizens believe in the legitimacy of this important component of European citizenship.
(Un)certainty in the Knowledge Society
Authors: Rek Mateja , Makarovič Matej , Škabar Matjaž
Published: November 2015

In this article we make an attempt to examine the relationship between knowledge society and perception of uncertainty both at conceptual as well as empirical level. The discussion is placed in the context of late modernity. The more optimistic views see in the knowledge society the possibility for progress, higher quality and safety of life. Other reflections draw attention also to different crisis-related tendencies and stress the possibility of generating uncertainty as a possible side effect of a developed knowledge society. We observe two trends that appear with the development of a knowledge society: the perception of existing certainty increases, but at the same time we can also see the increase of a desire for and openness to greater uncertainty in a society. Using qualitative comparative analysis we find that developed knowledge society is a sufficient condition for greater openness to uncertainty.
Role of Political Habitus in Shaping Dynamics of Democracy: Insights from Nehruvian and Gandhian Period of Democracy in India
Authors: Singh Sourabh
Published: November 2015

I have developed a theory regarding the relations among political structure, elite agency and democratization processes that overcomes the political structure/elite agency duality currently plaguing democracy consolidation studies. Using Bourdieu’s insights on the structure/agency relation to empirically examine the Nehruvian (1947–71) and Gandhian (1971–77) periods of Indian democracy, I show that the elite’s role in democratization processes is shaped by their political habitus, which in turn is structured by historically specific political structures. Furthermore, neither the elite’s political habitus nor the political structures that influence it are immune to change. Political structures are shaped by intraparty conflicts among the elite to establish their political authority. Since political structures change because of the changing state of conflict among the political elite, the milieu in which the elite’s political habitus is conditioned also changes. In the changing political milieu, the existent elite’s political sensibilities are reconfigured, and the sensibilities of the new generation of political elite, who have differing interests in democratization processes, become mature.
Recent Contributions to the Study of the Reception of the Bible and Their Implications for Biblical Studies in Africa
Authors: Stenschke Christoph
Published: November 2015

This article surveys a number of recent studies on the reception of biblical material in the Bible itself or in later works and periods. It endeavours to present studies that are representative of the nature and extent of the shift in the past two decades from the Bible itself to its rich reception history. An introductory section describes how recent developments in hermeneutics have shown to what extent hermeneutics is a historical discipline. After a detailed presentation and assessment, a final section draws some conclusion for the tasks ahead for biblical studies and related disciplines in Africa.
Finding the Sectarian Self
Authors: Wilson Walter T.
Published: November 2015

Elements of the Matthean mission discourse (Matt 10:5b–42) contributing to the evangelist’s sectarian agenda are identified and analyzed through comparison with the Hodayot, drawing on the work of Carol Newsom (The Self as Symbolic Space: Constructing Identity and Community at Qumran, 2004). Each composition is shown to address basic challenges of sectarian legitimation and differentiation by constructing a “figured” world in which subjectivities resistant to those promulgated by the dominant cultural script are articulated through the reaccentuation of normative idioms, situating these subjectivities in relation to mythoi of both the group’s leader and the group’s members. The two compositions are also shown to demonstrate significant differences, especially in terms of the types of normative idioms to which they appeal, the forms of experience and agency assigned the respective mythoi, and the manner in which the ideal sectarian subject negotiates the dynamics of self-alienation, non-acceptance, and conflict engendered by its interaction with the non-sectarian world.
Opera through Varying Theological Lenses
Authors: Hale Frederick
Published: November 2015

Although a great deal of scholarly attention has been devoted to Richard Wagner and his renowned works since the nineteenth century, and considerable attention has been given to Christian interpretations of them from continental European perspectives, many theological perspectives on the man and his operas in the English-speaking world have remained unilluminated. The present article seeks to redress aspects of that neglect by examining how two theologically educated British Nonconformists, namely P.T. Forsyth and Ramsden Balmforth (the latter of whose ministerial career was in Cape Town from 1897 until 1937) understood Wagner’s opera about the Holy Grail, Parsifal. It is argued that Forsyth’s interpretation was informed in large measure by his evolving understanding of the meaning of the Atonement and redemption, while Balmforth’s was shaped to a considerable degree by his Fabian socialism.
Exploring Bodily and Spatial Rhetoric in the De Opificio Dei of Lactantius
Authors: Vorster Johannes N.
Published: November 2015

In the construction of spatiality, “partitioning” (as Foucault would have it), or the formation of the “enclosure,” allows not only for the production of an object of knowledge, but prompted by the regulative procedures of a social order, also invests spaces with an almost inherent valorisation. The relations of power active in the production of demarcated space, not only allows for the disciplined production of knowledge within the boundaries of the enclosure, but it also enacts the principle of hierarchy, rendering some parts of more value than others, evoking reasons for boundaries, evaluating types of movement and mobility, thereby reproducing social order. How a version of an interior body was embedded within a rhetoric of spatiality in antiquity is the objective of this essay. The point of departure is not a pre-discursive interior body upon which a rhetoric of spatiality has been inscribed, but an already rhetorically constructed object of knowledge in interaction with a rhetoric of spatiality. Besides exploring the interaction of bodily and spatial rhetoric with reference to specific prominent issues in the Dei Opificio Dei of Lactantius, the question whether a version of Roman masculinity tropologically functions as proposal for the construction of social order is also posed.
What Do You Read When You Read a Religious Text?
Authors: van den Heever Gerhard
Published: November 2015

In this essay some key characteristics of contemporary discourse on biblical hermeneutics and philosophical hermeneutics are identified. A redescriptive archaeology of hermeneutics is suggested. The key characteristics of hermeneutics are re-interpreted and critiqued in light of recent theories of religion and history. There are three domains of critical questions at issue in the open question posed to the practice of hermeneutics, namely 1) redescriptive theorising of religion as a social discourse; 2) the materiality of the tradition; and 3) revisioning history and the relationship to the past.
Trevor Burnard, Planters, Merchants, and Slaves: Plantation Societies in British America, 1650–1820
Authors: Pestana (review) Carla Gardina , Emmer (review) Pieter , Robertson (review) James , Burnard (response) Trevor
Published: November 2015

This book forum focuses on Trevor Burnard’s book, Planters, Merchants, and Slaves: Plantation Societies in British America, 1650–1820 (University of Chicago Press, 2015). In his book, Burnard argues that white men did not choose to develop and maintain the plantation system out of virulent racism or sadism, but rather out of economic logic. While plantations required racial divisions to exist, their successes were always measured in gold, rather than skin or blood. Burnard argues that the best example of plantations functioning as intended is not those found in the fractious and poor North American colonies, but those in their booming and integrated commercial hub, Jamaica. Ranging over nearly two centuries, from Guyana to the Chesapeake, the book provides many new insights and offers a revisionary interpretation of the connection between slavery and the American Revolution. The three reviewers in general praise the empirical research that underpins the book but challenge some of the conclusions. They also draw attention to a few points that, in their opinion, the author underemphasized or where he could have expanded his argument, for instance the role of support from the British Empire to the plantation system and the role of religion in shaping attitudes to slavery and the plantation system. In his response, Burnard argues against some of the criticism, such as the impact of the fear of slave revolts. In particular, Burnard stresses that his understanding of slavery in the colonial period of American history is that of an outsider to American politics. As such, he argues, his book does not speak to contemporary concerns about rising evidence of racial hatred.
Endocan Levels and Subclinical Atherosclerosis in Patients With Systemic Lupus Erythematosus
Authors: Icli Abdullah , Cure Erkan , Cure Medine Cumhur , Uslu Ali Ugur , Balta Sevket , Mikhailidis Dimitri P. , Ozturk Cengiz , Arslan Sevket , Sakız Davut , Sahin Muhammed , Kucuk Adem
Published: November 2015

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology. A major cause of morbidity and mortality in SLE is accelerated atherosclerosis. Endothelial-specific molecule 1 (endocan) is a potential predictor of vascular events and is expressed in response to inflammatory cytokines in endothelial cells. We investigated the relationship between endocan and carotid intima–media thickness (cIMT) as a marker of early atherosclerosis. We included 44 women with SLE and 44 healthy women as controls. Disease severity of SLE was evaluated using the SLE Disease Activity Index. Endocan, C-reactive protein, erythrocyte sedimentation rate (ESR), and lipid panel were measured. The cIMT was 0.70 (range: 0.45-1.20) mm in patients with SLE and 0.40 (0.25-0.60) mm in controls ( P < .001). Endocan value was 1.6 ± 0.9 ng/mL in controls and 2.2 ± 1.0 ng/mL in patients with SLE ( P = .014). Endocan levels were positively correlated with cIMT ( r = .469, P < .001), body mass index ( r = .373, P = .013), and ESR ( r = .393, P = .008). Endocan level may be associated with subclinical atherosclerosis in SLE. Consequently, endocan levels may be a promising clinical tool for patients with SLE as a guide for preventive strategy.
Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation
Authors: Chen JiaYuan , Tang Buzhou , Lin YongQing , Ru Ying , Wu MaoXiong , Wang Xiaolong , Chen Qingcai , Chen YangXin , Wang JingFeng
Published: November 2015

To compare the predicative ability of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse cardiac events (MACEs) after stent implantation in patients with coronary artery disease (CAD). Studies were identified by electronic and manual searches. Twenty-six studies were included in the meta-analysis. The pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality (ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95% CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year ACM pooled C-statistics for clinical SYNTAX scores were significantly higher at 0.77 and 0.71, respectively ( Ps < .05). Both scoring systems predicted 1- and 5-year MACE equally well. The pooled risk ratio of the SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI: 1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the risk of major adverse cardiac and cerebrovascular events in each risk stratum. The SYNTAX score demonstrated minimal discrimination in predicting 1- or 5-year adverse cardiovascular events after percutaneous coronary intervention in patients with CAD. The clinical SYNTAX score could further improve the predictive capability for ACM but not MACE.