bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality Risk Stratification After Traumatic Brain Injury and Hazard of Death With Titrated Hypothermia in the Eurotherm3235Trial
Authors: Andrews Peter J. D. , Rodriguez Aryelly , Suter Peter , Battison Claire G. , Rhodes Jonathan K. J. , Puddu Irene , Harris Bridget A.
Published: March 2017

Objectives:

Hypothermia reduces intracranial hypertension in patients with traumatic brain injury but was associated with harm in the Eurotherm3235Trial. We stratified trial patients by International Mission for Prognosis and Analysis of Clinical Trials in [Traumatic Brain Injury] (IMPACT) extended model sum scores to determine where the balance of risks lay with the intervention.

Design:

The Eurotherm3235Trial was a randomized controlled trial, with standardized and blinded outcome assessment. Patients in the trial were split into risk tertiles by IMPACT extended model sum scores. A proportional hazard analysis for death between randomization and 6 months was performed by intervention and IMPACT extended model sum scores tertiles in both the intention-to-treat and the per-protocol populations of the Eurotherm3235Trial.

Setting:

Forty-seven neurologic critical care units in 18 countries.

Patients:

Adult traumatic brain injury patients admitted to intensive care who had suffered a primary, closed traumatic brain injury; increased intracranial pressure; an initial head injury less than 10 days earlier; a core temperature at least 36°C; and an abnormal brain CT.

Intervention:

Titrated Hypothermia in the range 32-35°C as the primary intervention to reduce raised intracranial pressure.

Measurements and Main Results:

Three hundred eighty-six patients were available for analysis in the intention-to-treat and 257 in the per-protocol population. The proportional hazard analysis (intention-to-treat and per-protocol populations) showed that the treatment effect behaves similarly across all risk stratums. However, there is a trend that indicates that patients in the low-risk group could be at greater risk of suffering harm due to hypothermia.

Conclusions:

Hypothermia as a first line measure to reduce intracranial pressure to less than 20 mm Hg is harmful in patients with a lower severity of injury and no clear benefit exists in patients with more severe injuries.
Improved Outcomes with Pedicled Nipple-sparing Mastectomies Using a New Surgical Delay: Mastectomy through Wise Incisions
Authors: Schwartz Jean-Claude D. , Skowronksi Piotr P.
Published: March 2017

Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique—a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions. This strategy also delays the Wise pattern flaps resulting in better wound healing, which is critical in implant-based reconstructions.
ABNORMAL VASCULAR COMPLEX WITHIN AN IDIOPATHIC EPIRETINAL MEMBRANE IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Gueunoun Sacha , Nazim Gabriela , Bruyère Elsa , Sieiro André , Souied Eric H. , Miere Alexandra
Published: March 2017

Purpose:

To report the case 70-year-old patient presenting with preretinal, abnormal vascularization accompanying an idiopathic epiretinal membrane (ERM), identified by optical coherence tomography angiography.

Methods:

Observational case report of one patient.

Results:

The authors describe the case of a patient presenting with an ERM on the right eye since March 2011, diagnosed by fundus biomicroscopy and spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany). At the last follow-up visit, the patient had a Snellen best-corrected visual acuity of 20/32 in her right eye and 20/20 in her left eye. Although on spectral domain optical coherence tomography the aspect on the right eye was unchanged since prior examination, optical coherence tomography angiography (Angiovue; Optovue, Fremont, CA) was able to reveal a high-flow, abnormal vascular network in the preretinal manual segmentation corresponding to the ERM.

Conclusion:

Spectral domain optical coherence tomography, routinely performed in these patients, may underestimate the presence of abnormal vascularization, as both preretinal neovascular complexes and thick ERMs appear as hyperreflective structures. Optical coherence tomography angiography allows a fast and depth-resolved visualization of these abnormal vascular complexes inside idiopathic ERMs. Diagnosis of a vascularized epiretinal structure could be noteworthy before decision of retinal surgery.
Intracranial Pressure Values Are Highly Variable After Cerebral Spinal Fluid Drainage
Authors: Rogers Michael , Stutzman Sonja E. , Atem Folefac D. , Sengupta Samarpita , Welch Babu , Olson DaiWai M.
Published: March 2017

Intracranial pressure (ICP) is often obtained via external ventricular drain (EVD) placement and is discussed as a key vital sign in neuroscience. Nurses are most often delegated the task of observing, adjudicating, and documenting ICP. Cerebrospinal fluid drainage requires that the transducer connected to the EVD is open to drain, prohibiting ICP monitoring. There are no recent data to support an evidence-based standard for the period an ICP waveform should be observed, after the EVD is clamped, to be able to adjudicate a value that represents the patient’s status. Therefore, the purpose of this study is to determine the optimal period for which an EVD should be closed to obtain an accurate ICP value. In a sample of 30 subjects who received continuous ICP monitoring for 15 minutes, there was no universal pattern to ICP after clamping an EVD. The conditional probability of observing a patient’s highest ICP, if ICP is observed for 5 minutes, is 0.0181. The conditional probability increased to 0.0402 if ICP is observed for 10 minutes. There were no instances of ICP elevation requiring intervention. The results suggest that at least 5 minutes of ICP monitoring is safe and is required to provide an ICP value that reflects true ICP.
Campaign for the Brain
Authors: Marshall Jolene
Published: March 2017

A stroke alert is an emergency. An event in the brain can end in long-term deficits that may be prevented if attention is given to the signs. The message needs to be told. Be fast. This is a poem to promote code stroke.
Risk Factors for Poststroke Depression: An Integrative Review
Authors: Babkair Lisa A.
Published: March 2017

Background: Poststroke depression (PSD) is the most common stroke-related emotional disorder and affecting one-third of stroke survivors at any time up to 5 years after stroke. Poststroke depression affects rehabilitation after stroke and may delay recovery. The purpose of this integrative review is to analyze the state of the science in regard to risk factors for PSD. Methods: The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were searched. Inclusion criteria included (1) peer-reviewed primary observational Western studies, (2) PSD as the primary outcome, (3) included adult stroke survivors, and (4) and published after 2004. The integrative review guidelines were used for analysis. Results: From an original of 406 articles identified, 18 met the inclusion criteria and were reviewed: 3 cross-sectional, 14 prospective cohort, and 1 case control. The most common risk factors associated with PSD are stroke severity, cognitive impairment, physical disability, and functional dependency. Others factors including demographic and social factors and medical history were not consistent across studies. Conclusions: Overall, quality of the research was limited by small sample sizes, selection bias, number of selected variables, and lack of multivariate analyses. Nurses should identify patients at risk for PSD through early depression screening and provide interventions to enhance rehabilitation and improve recovery.
Clinical Predictors for KRAS Codon 13 Mutations in Patients With Colorectal Cancer
Authors: Kwak Min S. , Cha Jae M. , Cho Young H. , Kim Sang H. , Yoon Jin Y. , Jeon Jung W. , Shin Hyun P. , Joo Kwang R. , Lee Joung I.
Published: March 2017

Goals:

This study sought to clarify sex differences in KRAS mutations and clinical predictors of KRAS 13 codon mutations.

Background:

Sex differences in KRAS mutations and predictors for KRAS codon 13 mutations in colorectal cancer (CRC) are unclear.

Study:

Between October 2007 and May 2016, 328 patients underwent surgery for CRCs that were analyzed for KRAS mutations at a referral university hospital. Sex differences in the rates and distributions of KRAS mutations, and factors predictive of overall KRAS and KRAS codon 13 mutations were analyzed.

Results:

KRAS mutations were significantly more common in women than men patients (46.0% vs. 34.4%, P<0.033). However, no sex differences were detected for KRAS mutations by codon subtypes (P=0.592). The Gly13Asp (GGC>GAC) point mutation was identified only within codon 13 in both sexes. For right-sided CRC, KRAS mutations were twice as frequent in men as in women (univariate analysis; P=0.016, multivariate analysis; P=0.019). High-plasma cholesterol level was an independent predictive factor of KRAS codon 13 mutations by univariate (odds ratio, 1.013; 95% confidence interval, 1.003-1.023) and multivariate analysis (odds ratio, 1.011; 95% confidence interval, 1.001-1.021).

Conclusions:

Sex differences may affect the presentation of KRAS mutations, as they were more frequently detected in women and in right-sided CRC in men. KRAS codon 13 mutations were significantly associated with high-plasma cholesterol. Further studies are needed on the clinical implications of this finding.
Functional neuroimaging in obesity
Authors: Patriarca Laura , Magerowski Greta , Alonso-Alonso Miguel
Published: March 2017

Purpose of review

This review examines recent advances in the use of functional neuroimaging to study human obesity, a field that is rapidly expanding and continues to be of paramount importance for a better understanding of the pathogenesis of this condition. With rising levels of obesity worldwide and limited therapeutic options, there is a great need for the development of new solutions that can benefit patients.

Recent findings

Studies that utilize functional neuroimaging are beginning to shed light on the nature of behavioral and neurocognitive dysfunctions previously identified in individuals with obesity. Significant progress has occurred in the study of reward-related processes, cognition–reward interactions, mechanisms of weight loss, genetic influences and the case of obesity in children and adolescents. Research findings confirm that obesity and its related overeating behaviors are strongly associated with the brain, both at a regional level and a large-scale network level.

Functional neuroimaging studies bring unprecedented levels of detail to examine the brain basis of obesity and show promise for the development of future brain-based biomarkers and interventions in this condition.
Managing dysphagia in trachesotomized patients: where are we now?
Authors: Goff Diane
Published: March 2017

Purpose of review

Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients.

Recent findings

The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire.

In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging.
Social and quality of life impact using a voice prosthesis after laryngectomy
Authors: Summers Lizz
Published: March 2017

Purpose of review

This review is intended to give an up-to-date overview of key developments in the evidence base relating specifically to the social and quality of life (QOL) impact of using a voice prosthesis, with reflections on the impact on clinical practice.

Recent findings

Recent studies have shed light on the role of social support on psychological adjustment after laryngectomy, developing the existing evidence base on psychological sequelae. Investigations into the relationship between voice intensity/intelligibility and voice handicap/QOL may suggest a relationship for some patients, and current tools for measuring these constructs are evaluated. Recent qualitative research on the lived experience and social impact of using a voice prosthesis is presented.

Little research is currently available exploring the impact of using a voice prosthesis on social participation, which is reflected in the dearth of participation-focused interventions for laryngectomy patients. Further research on the lived experience of tracheoesophageal speech is required to understand this phenomenon and develop appropriate interventions for enhancing communication, participation and QOL with a voice prosthesis after laryngectomy.
Endometrioid Adenocarcinoma Arising in a Paratubal Cyst: A Case Report and Review of the Literature
Authors: Chang Catherine , Matsuo Koji , Mhawech-Fauceglia Paulette
Published: March 2017

A 56-year-old G3P3 postmenopausal woman presented with a 5 month history of abnormal uterine bleeding and pelvic pain. A computed tomographic scan revealed a 5 cm right adnexal cystic mass in addition to a thickened, heterogenous endometrium and leiomyomatous uterus. A total laparascopic hysterectomy and bilateral salpingo-oophorectomy with omental and peritoneal biopsy were performed. Gross examination revealed a 12 week size uterus with small fibroids, normal bilateral atrophic ovaries, and a right paratubal cyst. A 4 cm vegetating mass was found in the right side of the uterine wall. Microscopically, the uterine mass was diagnosed as an endometrioid adenocarcinoma (EAC) FIGO 1 with 70% of myometrial invasion. The remaining endometrium showed a complex atypical hyperplasia. In addition, a 5 cm paratubal cystic mass was found that was separate from the uterus and the right adnexa. The cyst content was a chocolate brown fluid and the cyst wall was smooth with a single solid mass of 2 cm in size. The diagnosis of EAC, FIGO 1 was given. The remaining cyst lining showed endometriotic cyst and foci of endometriosis in the cyst wall. There was no lymphovascular invasion. The entire fallopian tube and ovaries were submitted and they were free of tumor. The patient was diagnosed with primary EAC of the paratubal cyst in addition to EAC of the uterine corpus (pT1b). A close follow-up was recommended. Because of our limited knowledge of carcinomas arising in the paratubal cyst, we will review the literature and discuss their clinical aspects, management, and behavior.
Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations
Authors: Hendrickson Marissa A. , Obeya Eta , Wey Andrew R. , Gaillard Philippe R.
Published: March 2017

Background

Children who present to emergency departments (EDs) for care are frequently advised to follow up with their primary care providers (PCPs) after discharge; little is known about whether PCPs agree that follow-up advised by EDs is appropriate for their patients.

Objectives

The aims of this study were to determine PCP preferences for follow-up recommendations given to their pediatric patients at the time of ED visits and to compare these preferences to reported emergency medicine provider (EMP) practice.

Methods

This was an online survey of PCPs and EMPs in a regional health system assessing preferred timing for ED follow-up recommendations for 15 common pediatric conditions and whether the follow-up should be definite or contingent.

Results

Ninety PCPs and 36 EMPs responded to the survey. In patients with community-acquired pneumonia, probability of recommending follow-up after 5 or more days was 33% in PCPs and 8% in EMPs (P = 0.001). In all conditions with significant differences, PCPs favored longer follow-up. In upper respiratory tract infection and acute otitis media, PCPs had a higher probability than EMPs of selecting as-needed versus definite follow-up (P = 0.0002 and P = 0.01, respectively). In asthma, concussion, and pneumonia, PCPs had a significantly lower probability of selecting as-needed follow-up than EMPs.

Conclusions

In this regional survey, PCPs preferred longer times between ED visit and follow-up than EMPs for a number of conditions. Differences were also found in preference for as-needed or definite follow-up, varying by condition. These discrepancies could result in overuse or underuse of clinic resources, suggesting a possible quality improvement target for emergency medicine practice.
Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network
Authors: Hendrickson Marissa A. , Wey Andrew R. , Gaillard Philippe R. , Kharbanda Anupam B.
Published: March 2017

Objectives

Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis.

Methods

This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children’s hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention.

Results

Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%–51%, P = 0.049), and CT scan use decreased (81%–66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%–97%, P = 1.000) or CT scan rate (13%–10%, P = 1.000) among children’s ED patients with imaging.

Conclusions

An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children’s hospital to affiliated community EDs.
Epidemic Adolescent Binge Drinking at Lollapalooza, A Music Festival in Chicago
Authors: McAndrew Sarah E. , Smith Tracie L. , Groothuis Elizabeth , Koressel Lindsay R. , Unti Sharon M. , Powell Elizabeth C. , Tanz Robert R.
Published: March 2017

Objectives

Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival.

Methods

We performed a retrospective chart review of adolescent (aged 11–20 years) ED visits during LP weekend and 4 summer comparison weekends at Lurie Children’s Hospital in Chicago, Ill, in 2014 (n = 356). We then analyzed adolescent alcohol- and drug-related hospital visits to all Chicago hospitals for each weekend in 2014 0 using Illinois hospital discharge data.

Results

Adolescents accounted for a greater proportion of our ED visits during LP weekend than comparison weekends (25% vs 19%, P < 0.02). Lollapalooza weekend patients were more likely female (P = 0.025), older (P = 0.0067), more often unsupervised (P < 0.0001), and less likely to live in the city (P < 0.001) than adolescents seen during comparison weekends. Thirty-one underage adolescents who attended LP were treated in our ED; 84% were intoxicated (blood alcohol content, 88–328 mg/dL). Citywide there was an 11-fold increase in adolescent alcohol-related hospital visits during LP weekend compared with an average weekend. Drug intoxication was much less common.

Conclusions

Adolescents seen in our ED the weekend of LP were older, more often female, frequently unsupervised, and less likely to be city residents than those seen during comparison weekends. Those who attended LP had high rates of alcohol intoxication. This surge of intoxicated adolescent patients affected numerous EDs in the city.
Clear Cell Carcinoma of the Uterine Cervix Presented as a Submucosal Tumor Arising in a Background of Cervical Endometriosis
Authors: Hashiguchi Mariko , Kai Keita , Nishiyama Satoshi , Nakao Yoshifumi , Yokoyama Masatoshi , Aishima Shinichi
Published: March 2017

Clear cell carcinoma (CCC) of the uterine cervix without prenatal diethylstilbestrol exposure is rare, and its etiology is unclear. We present a case of cervical CCC presenting as a submucosal tumor, which strongly suggests an association between cervical endometriosis and cervical CCC. A 56-year-old postmenopausal Japanese woman visited a gynecologic clinic with a complaint of watery vaginal discharge. A few atypical cells suggesting adenocarcinoma were detected in a cervical cytologic specimen. Magnetic resonance imaging revealed a cystic lesion with a solid component at the uterine cervix. Under a tentative diagnosis of cervical cancer, surgery was performed. Although a freshly resected specimen initially showed no tumorous lesion in the cervical mucosa, cutting of the mucosa revealed a solid tumor with a final diagnosis of CCC. The findings of aggregation of hemosiderin-laden macrophages and ectopic endometrium adjacent to the tumor strongly suggest that this tumor arose from cervical endometriosis.
A Treat-to-Target Strategy Preserves Work Capacity in a Rheumatoid Arthritis Inception Cohort Treated With Combination Conventional DMARD Therapy
Authors: Wechalekar Mihir D. , Quinn Stephen , Lester Susan , Metcalf Robert G. , Shanahan Ella , Walker Jennifer G. , Smith Malcolm D. , Hill Catherine L. , Shanahan E. Michael , Proudman Susanna M.
Published: March 2017

Objectives

Quantification of work disability in patients with early rheumatoid arthritis (RA) receiving conventional DMARDs according to a treat-to-target strategy.

Methods

This is a retrospective cohort analysis of RA patients who received combination conventional DMARDs, escalated to achieve DAS28(ESR) remission and completed an annual work and arthritis questionnaire. Random effect mixed modeling was used to assess associations between average hours worked per week (HWPW), and baseline prognostic factors. HWPW were compared with matched population averages. Cox proportional hazards modeling was employed to evaluate associations between permanent loss of employment and treatment response, disease and demographic factors.

Results

Work data from 135 patients working at baseline and 137 working at any point followed for up to 14 years (range 1–14) were available for analysis. The mean age was 45 years, 70% were female, and 70% and 68% were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP), respectively. Men worked more hours than women; there was a highly significant association between working hours lost and increasing age (0.28 hours, P = 0.04) and female gender (11.92 hours, P < 0.001). HWPW were maintained over the study time comparable to the general population (loss of 0.78 vs. 0.24 HWPW). EULAR good responders at 6 months were more likely to be working at 10 years compared to those with moderate/no response. Permanent loss of employment and baseline age were strongly associated for anti-CCP positive participants (P = 0.04).

Conclusions

Treat-to-target combination conventional DMARD therapy maintains work capacity, particularly in good responders, comparable to the general population. Improving treatment response in moderate/no responders early in disease may increase work retention.
Correlation Between Transperineal 3-Dimensional Ultrasound Measurements of Levator Hiatus and Female Sexual Function
Authors: Aydin Serdar , Bakar Rabia Zehra , Arioğlu Aydin Çağri , Ateş Seda
Published: March 2017

Objective

The aim of this study is to investigate the association of sexual functions with levator hiatus biometry measurements and levator ani muscle defect.

Methods

In 62 heterosexual, sexually active premenopausal women without pelvic floor disorders or urinary incontinence, 3-dimensional transperineal ultrasound imaging was used. Two 3-dimensional volumes were recorded, one at rest and one on Valsalva maneuver. Levator biometry measurements and levator defect were evaluated in an axial plane. Sexual function was assessed by a validated questionnaire, Female Sexual Function Index (FSFI). The primary outcome measure was correlation of sexual functions with the levator hiatus area, transverse and anteroposterior diameters, levator ani muscle thickness, vaginal length, and changes in measurements with Valsalva and levator defect.

Results

Forty-two women (67.7%) had low total FSFI scores (<26.55). Levator defect rates were similar in female sexual dysfunction (7/42, 16.7%) and women without female sexual dysfunction (5/20, 25%). The FSFI was negatively and weakly correlated with Δhiatal anteroposterior diameter (r = −0.33, P < 0.009) in the study population. There was a weak and inverse correlation between Δhiatal anteroposterior diameter and arousal (r = −0.35, P < 0.002), desire (r = −0.38, P < 0.001), and orgasm (r = −0.33, P < 0.007). Pain and lubrication did not correlate with any measurement.

Conclusions

Hiatal area and diameters at rest are not related to sexual functions. Changes in anteroposterior diameter of the levator hiatus during Valsalva, which may be a sign of pelvic floor laxity or levator muscle weakness, are weakly associated with sexual functions, particularly desire, arousal, and orgasm domains.
Divergence Palsy due to Divalproex and Oxcarbazepine
Authors: Bouffard Marc Albert , Caplan Louis R. , Torun Nurhan
Published: March 2017

Objective

This case series is the first to describe divergence palsy as an adverse effect of antiepileptic drug use. Diplopia is a common adverse effect of antiepileptic drugs, but no explanatory motility deficit has ever been reported.

Methods

We present 2 patients, 1 on oxcarbazepine and 1 on divalproex, each with a normal examination result between spells and divergency palsy when symptomatic.

Results

Discontinuation of the antiepileptic medication led to resolution of the episodes in both cases. Rechallenge with the offending agent after washout in one patient resulted in recurrence of diplopia and divergence palsy, both resolving after subsequent withdrawal of the antiepileptic.

Conclusions

Antiepileptic drugs may cause divergence palsy.
Thrombolytic Therapy in Wake-Up Stroke Patients
Authors: Stern Gretchen M. , Van Hise Nicholas , Urben Lindsay M. , Korobey Matthew J. , Pitlick Jamie M. , Crannage Andrew J.
Published: March 2017

Objective

The aim of the study is to review existing and ongoing trial data on wake-up stroke (WUS) patients for thrombolytic therapy.

Methods

A literature search was conducted in PubMed (conception–October 2016) using the terms wake-up stroke, acute ischemic stroke, wake-up thrombolysis, computed tomography imaging in wake-up stroke, and magnetic resonance imaging in wake-up stroke. Ongoing trials were found using the ClinicalTrials.gov website.

Results

The search yielded 61 articles in PubMed and 7 ongoing trials. After removing duplicate/irrelevant articles, 33 articles and relevant references were reviewed; of these, 6 articles and 3 ongoing trials were included. Two retrospective studies evaluating the characteristics between WUS and known-onset stroke were identified; the only significant difference between groups was the ability to receive treatment with tissue plasminogen activator (tPA). One study suggested that perfusion brain imaging may be useful to identify patients that may benefit from tPA. In addition, 3 studies have evaluated WUS treatment; all used different methods to identify potential patients. Two of 3 studies showed that treatment with tPA is associated with better outcomes when controlling for baseline National Institutes of Health Stroke Scale. No difference in safety outcomes was seen between groups for all 3 studies.

Conclusions

Available data suggest promising strategies to identify WUS patients who may benefit from thrombolysis. Once on-going trials are complete, there may be sufficient information to redefine tPA eligibility for previously excluded patients.
Fast and Robust Inference of Phylogenetic Ornstein-Uhlenbeck Models Using Parallel Likelihood Calculation
Authors: Mitov Venelin , Stadler Tanja
Published: March 2017

Abstract

Phylogenetic comparative methods have been used to model trait evolution, to test selection versus neutral hypotheses, to estimate optimal trait-values, and to quantify the rate of adaptation towards these optima. Several authors have proposed algorithms calculating the likelihood for trait evolution models, such as the Ornstein-Uhlenbeck (OU) process, in time proportional to the number of tips in the tree. Combined with gradient-based optimization, these algorithms enable maximum likelihood (ML) inference within seconds, even for trees exceeding 10,000 tips. Despite its useful statistical properties, ML has been criticised for being a point estimator prone to getting stuck in local optima. As an elegant alternative, Bayesian inference explores the entire information in the data and compares it to prior knowledge but, usually, runs in much longer time, even for small trees. Here, we propose an approach to use the full potential of ML and Bayesian inference, while keeping the runtime within minutes. Our approach combines (i) a new algorithm for parallel likelihood calculation; (ii) a previously published method for adaptive Metropolis sampling. In principle, the strategy of (i) and (ii) can be applied to any likelihood calculation on a tree which proceeds in a pruning-like fashion leading to enormous speed improvements. As a showcase, we implement the phylogenetic Ornstein-Uhlenbeck mixed model (POUMM) in the form of an easy-to-use and highly configurable R-package. In addition to the above-mentioned usage of comparative methods, the POUMM allows to estimate non-heritable variance and phylogenetic heritability. Using simulations and empirical data from 487 mammal species, we show that the POUMM is far more reliable in terms of unbiased estimates and false positive rate for stabilizing selection, compared to its alternative - the non-mixed Ornstein-Uhlenbeck model, which assumes a fully heritable and perfectly measurable trait. Further, our analysis reveals that the phylogenetic mixed model (PMM), which assumes neutral evolution (Brownian motion) can be a very unstable estimator of phylogenetic heritability, even if the Brownian motion assumption is only weakly violated. Our results prove the need for a simultaneous account for selection and non-heritable variance in phylogenetic evolutionary models and challenge stabilizing selection hypotheses stated in numerous macro-evolutionary studies.
Pancreatic α- and β-cellular clocks have distinct molecular properties and impact on islet hormone secretion and gene expression
Authors: Petrenko Volodymyr , Saini Camille , Giovannoni Laurianne , Gobet Cedric , Sage Daniel , Unser Michael , Heddad Masson Mounia , Gu Guoqiang , Bosco Domenico , Gachon Frédéric , Philippe Jacques , Dibner Charna
Published: March 2017

A critical role of circadian oscillators in orchestrating insulin secretion and islet gene transcription has been demonstrated recently. However, these studies focused on whole islets and did not explore the interplay between α-cell and β-cell clocks. We performed a parallel analysis of the molecular properties of α-cell and β-cell oscillators using a mouse model expressing three reporter genes: one labeling α cells, one specific for β cells, and a third monitoring circadian gene expression. Thus, phase entrainment properties, gene expression, and functional outputs of the α-cell and β-cell clockworks could be assessed in vivo and in vitro at the population and single-cell level. These experiments showed that α-cellular and β-cellular clocks are oscillating with distinct phases in vivo and in vitro. Diurnal transcriptome analysis in separated α and β cells revealed that a high number of genes with key roles in islet physiology, including regulators of glucose sensing and hormone secretion, are differentially expressed in these cell types. Moreover, temporal insulin and glucagon secretion exhibited distinct oscillatory profiles both in vivo and in vitro. Altogether, our data indicate that differential entrainment characteristics of circadian α-cell and β-cell clocks are an important feature in the temporal coordination of endocrine function and gene expression.
Entrepreneurial path: decoupling the complexity of entrepreneurial process
Authors: Galanakis Kostas , Giourka Paraskevi
Published: March 2017

Purpose

The purpose of this paper is to synthesise the socioeconomic context, personality, knowledge and social capital into a systemic framework, named the “entrepreneurial path” that demonstrates the process of transforming initial entrepreneurial intentions to a growing venture. This systemic framework decouples the overall complexity of the entrepreneurial realisation to three main subsystems: entrepreneurial intentions and venture idea formation; barriers of transition from nascent to active entrepreneur; and active and growing ventures.

Design/methodology/approach

The paper employs a systemic thinking approach to decouple the complexity of the subject. Survey techniques and digital social network discussion forums were used for the collection of primary qualitative data from multiple stakeholders.

Findings

The conceptual framework, named the entrepreneurial path, highlights the importance of different factors at each stage of the entrepreneurial realisation. Especially the importance of factors such as perceived desirability, feasibility, self-efficacy, network ties and social capital has been identified as central. Needs for managerial skills and resources for the new venture come to play only on the later stage. Each of those factors though, plays a distinctive role in the different stages of the realisation and in dependence to the maturity of the entrepreneurial context.

Research limitations/implications

Further research may examine whether these factors that have been identified by successful entrepreneurs and stakeholders are reflecting the experience for those who have not been successful in their effort to create their venture.

Practical implications

The entrepreneurial path provides a supportive tool for: academics designing focussed entrepreneurship education programmes and research; managers in intermediate structures to identify the specific needs of nascent and early-stage entrepreneurs in comparison to the needs of entrepreneurs in the growth stage; and for policy makers prioritising on supportive structures and institutions directing their actions to specific stages or barriers of the process or creating holistic and evolving structures based on the maturity of the entrepreneurial context.

Originality/value

The decoupling of the process of transforming initial entrepreneurial intentions to a growing venture demonstrates that different approaches are required in order to foster each one of the factors identified. Focussing on activities and resources on one stage at the time, or presenting parallel activities that reflect the different level of maturity of regions, institutions, individuals and societal perceptions may provide better service to nascent and active entrepreneurs, than considering treating entrepreneurial intentions as a unified process.
Robot programming by demonstration using teleoperation through imitation
Authors: Jha Abhishek , Chiddarwar Shital S.
Published: March 2017

Purpose

This paper aims to present a new learning from demonstration-based trajectory planner that generalizes and extracts relevant features of the desired motion for an industrial robot.

Design/methodology/approach

The proposed trajectory planner is based on the concept of human arm motion imitation by the robot end-effector. The teleoperation-based real-time control architecture is used for direct and effective imitation learning. Using this architecture, a self-sufficient trajectory planner is designed which has inbuilt mapping strategy and direct learning ability. The proposed approach is also compared with the conventional robot programming approach.

Findings

The developed planner was implemented on the 5 degrees-of-freedom industrial robot SCORBOT ER-4u for an object manipulation task. The experimental results revealed that despite morphological differences, the robot imitated the demonstrated trajectory with more than 90 per cent geometric similarity and 60 per cent of the demonstrations were successfully learned by the robot with good positioning accuracy. The proposed planner shows an upper hand over the existing approach in robustness and operational ease.

Research limitations/implications

The approach assumes that the human demonstrator has the requisite expertise of the task demonstration and robot teleoperation. Moreover, the kinematic capabilities and the workspace conditions of the robot are known a priori.

Practical implications

The real-time implementation of the proposed methodology is possible and can be successfully used for industrial automation with very little knowledge of robot programming. The proposed approach reduces the complexities involved in robot programming by direct learning of the task from the demonstration given by the teacher.

Originality/value

This paper discusses a new framework blended with teleoperation and kinematic considerations of the Cartesian space, as well joint space of human and industrial robot and optimization for the robot programming by demonstration.
Culture and gender’s role in apparel purchasing patterns
Authors: Nieves-Rodriguez Elsa , Perez-Rivera Myra Mabel , Longobardi Teresa , Davis-Pellot Jose A.
Published: March 2017

Purpose

Scholars recognize that international marketing effectiveness requires adapting to cultural values, and at the same time, paradoxically, acknowledge the possibility of cultural convergence. The purpose of this paper is to take the context of Puerto Rico as a US territory to reconcile these two propositions by analyzing culture and gender’s influence on apparel purchase.

Design/methodology/approach

Via multiple regression analysis, the study considers seasonality as a factor of apparel purchase patterns, developing a consumer behavior model for the apparel industry.

Findings

Results confirm that culture influences purchase behavior, an influence moderated by gender. Additionally, they show that seasons and special occasions are strong predictors of apparel purchase patterns.

Research limitations/implications

The findings assert the claims of cultural convergence, yet preserve the notion that cultural values are reflected in patterns of consumer behavior in the case of apparel.

Practical implications

The study develops highly explanatory models indicating that Puerto Rico expenditure reflects cultural patterns of special occasions, but overshoots expectations for its US counterpart.

Originality/value

The results show that Puerto Rico has appropriated several US cultural aspects (e.g. special holidays), which are expressed differently as reflected by apparel purchase behavior, supporting the notion that Puerto Rico should be treated as an international market. The study demonstrates that cross-cultural studies may be robust in absence of available Hofstede’s dimensions for a country.
Validating fashion brand centrality scale amongst young adults
Authors: Sarkar Abhigyan , Sarkar Juhi Gahlot
Published: March 2017

Purpose

The purpose of this paper is to develop and validate a psychometrically reliable scale to measure centrality of brand (CoB) or brand centrality construct in the domain of fashion apparel brands. The scale quantitatively validates that brand relationship can be of equivalent importance to religious relationship in an individual fashion brand lover’s life.

Design/methodology/approach

Based on a previous literature review, brand centrality has been conceptualized. Following that, CoB scale has been validated in a step-by-step process following the scale validation methodology suggested by Churchill (1979).

Findings

The final outcome of the study is a psychometrically reliable CoB scale. The study results validate the relationships between CoB, and other important theoretical antecedents and consequences of brand centrality.

Originality/value

This study contributes to the existing body of fashion branding research by showing that a consumer-fashion brand relationship can be of importance akin to a religious relationship in an individual’s life.
Relationships between Italian companies’ operational characteristics and business growth in high and low lean performers
Authors: Bevilacqua Maurizio , Ciarapica Filippo Emanuele , De Sanctis Ilaria
Published: March 2017

Purpose

The purpose of this paper is to analyze relationships between operational characteristics and business growth in Italian manufacturing companies comparing high lean performers (HLPs), which are companies with a high degree of application of lean practices, and low lean performers (LLPs). This analysis aims at highlighting the effect of the implementation level of lean practices on operational characteristics of Italian companies and, as a consequence, on business growth.

Design/methodology/approach

A classification in “LLPs” and “HLPs” of Italian manufacturing industries has been developed in order to measure the company’s degree of application of lean practices. A survey was carried out, and a combination of cluster analysis and multi-group structural equation path model was developed in order to answer research hypotheses.

Findings

Results suggest that HLPs are characterized by a greater number of employees and a larger turnover. The operational characteristics that contribute to the business growth owing to the introduction of lean practices are as follows: the range of different finished products managed, the delivery reliability, and speedy response to warranty claim. No differences between HLPs and LLPs in terms of business growth have been highlighted when companies vary the batch size, reduce the medium production time, reduce the percentage of finished products which are subject to claim, and increase the percentage (of turnover) of R&D investment. The study highlights that “LLPs” companies are apparently capable of changing their production schemes and adjusting themselves better for customizing their products.

Practical implications

Companies that aim at implementing lean practices should focus their attention on practices that affect the operational characteristics that contribute to the business growth. Moreover, because of the complexity and effort for the implementation of certain lean practices connected to supplier, workforce, quality, and production efficiency, these practices are more suitable only for large firms with enough resources.

Originality/value

As an attempt to offer strategic and operational perspective on Italian lean practices implementation, this study examined how the degree of application of the different lean practices has an impact on operational and companies’ performance. Hence, even if the present study is limited to the Italian manufacturing companies, it could be a representative of companies that are operating in developed countries that are facing the so-called “anemic growth.”
An intelligent decision support system for on-demand fixture retrieval, adaptation and manufacture
Authors: Kasie Fentahun Moges , Bright Glen , Walker Anthony
Published: March 2017

Purpose

The purpose of this paper is to propose a decision support system (DSS) that stabilizes the flow of fixtures in manufacturing systems. The proposed DSS assists decision-makers to reuse or adapt the available fixtures or to manufacture new fixtures depending upon the similarity between the past and new cases. It considers the cost effectiveness of the proposed decision when an adaptation decision is passed.

Design/methodology/approach

The research problem is addressed by integrating case-based reasoning, rule-based reasoning and fuzzy set theory. Cases are represented using an object-oriented (OO) approach to characterize them by their feature vectors. The fuzzy analytic hierarchy process (FAHP) and the inverse of weighted Euclidean distance measure are applied for case retrieval. A machining operation is illustrated as a computational example to demonstrate the applicability of the proposed DSS.

Findings

The problems of fixture assignment and control have not been well-addressed in the past, although fixture management is one of the complex problems in manufacturing. The proposed DSS is a promising approach to address such kinds of problems using the three components of an artificial intelligence and FAHP.

Research limitations/implications

Although the DSS is tested in a laboratory environment using a numerical example, it has not been validated in real industrial systems.

Practical implications

The DSS is proposed in terms of simple rules and equations. This implies that it is not complex for software development and implementation. The illustrated numerical example indicates that the proposed DSS can be implemented in the real-world.

Originality/value

Demand-driven fixture retrieval and manufacture to assign the right fixtures to planned part-orders using an intelligent DSS is the main contribution. It provides special consideration for the adaptation of the available fixtures in a system.