bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP401: Residual Shunting Post PFO Closure is Associated With Increased Long-term Risk of Recurrent Stroke
Authors: Deng Wenjun , Song Bo , Fisher Lindsay , Chou Richard I , Oyer Maxwell , Bunda Bridget , Wang Andrew , Inglessis Ignacio , Elmariah Sammy , Sakhuja Rahul , McMullin David , Lo Eng H , Palacios Igor , Buonanno Ferdinando S , Ning MingMing
Published: October 2018

Background:
Patent foramen ovale (PFO) is an independent risk factor for ischemic stroke, and recent clinical trials have shown long-term benefit of PFO closure. We previously found PFO may increase the risk of stroke due to right-to-left shunting, resulting in venous contamination of arterial circulation, with elevated neurovascular mediators such as homocysteine. However, in clinical practice, residual blood shunting can be observed in ~10% of patients post PFO closure, with unclear significance. Here we prospectively investigated the long-term influence of residual shunting on patient outcome.

Method:
1018 PFO stroke patients s/p PFO closure from several medical centers were prospectively recruited in accordance with IRB protocol and followed up to 7 years.

Result:
While closure rate at our center is much lower (<5%), overall closure rate of patients from all major referral centers range between 5-14%. Patients with compete PFO closure (86%) developed higher event-free probability from recurrent TIA/stroke compared to those with residual shunting (14%) (Figure1A, p = 0.001). The risk of recurrent stroke depended on residual shunt size with lower event-free probability in larger shunting (Figure 1B, p = 0.002).

Conclusion:
Consistent with clinical trials, our prospective observational study suggests complete PFO closure results in lower risk of stroke recurrence. Patients with residual shunting (incomplete PFO closure) may face continued risk, though the overall risk of stroke recurrence is very low. PFO-related shunting appears to be critical in the pathophysiology of recurrent stroke.
Abstract WP420: Lesions Associated With Impaired Expression of Emotion Right Hemisphere Stroke
Authors: Patel Sona , Oishi Kenichi , Wright Amy , Saxena Sadhvi , Hillis Argye E
Published: October 2018

Introduction:
Impaired expression of emotion through tone, loudness, rate, and rhythm of speech (affective prosody) is common after right hemisphere (RH) stroke and impedes all social interactions.

Hypothesis:
Abnormal patterns of acoustic features correlate with listener judgment of affective prosody and are associated with infarcts of specific RH gray and white matter regions.

Methods:
Forty acute ischemic RH stroke patients had MRI DWI and described a picture within 48 hours of onset. Affective prosody of picture descriptions was rated by 21 healthy volunteers (1-7 scale). We identified acoustic features that correlated with listener ratings with Spearman correlations and with linear regression to identify independent predictors. A neurologist identified percent damage to each of 9 regions after co-registration of DWI to an atlas. We identified lesions associated with abnormalities in important acoustic features using logistic regression.

Results:
Listener ratings of prosody correlated with duration of voiced segments divided by total duration of speech segments(DurV/Dur) (rho=0.63; p<0.00001) and Spectral Flatness (SF) (rho= -0.55; p=0.0002). Variability in listener rating was best accounted for by DurV/Dur, SF, pitch range, and fundamental frequency coefficient of variation (CoV) in both women (F (4,12) =6.58; p=0.0048) and men (F(5,18)=5.13; p=0.0056). The only feature independently associated with prosody rating after adjusting for other variables was DurV/Dur (p<0.0001) for women, and SF (p=0.007) for men. Low SF was predicted by sex, age, lesion volume, and percent damage to the 9 RH regions (X
2
=27; p=0.0081). Sex, lesion volume, damage to inferior frontal gyrus pars opercularis, inferior fronto-occipital fasciculus, superior longitudinal fasciculus (SLF), and uncinate were the only independent predictors. The same variables predicted CoV (X
2
=33; p=0.0005); age and damage to supramarginal gyrus and SLF were the only independent predictors. The same variables plus education predicted low DurV/Dur (X
2
=25; p=0.02).

Conclusions:
Impaired emotional expression after RH stroke is due to changes in specific acoustic features caused by infarct in right pars opercularis or supramarginal gyrus, or associated white matter tracts.
Abstract WP421: Remote Ischemic Injury Mediates Hippocampal Astrocytic Endfeet Remodeling, Increases Vascular Injury and Worsens Cognitive Deficits in Diabetes
Authors: Ward Rebecca , Li Weiguo , Fagan Susan C , Ergul Adviye
Published: October 2018

Diabetes increases the risk and severity of cognitive impairment, especially after ischemic stroke. We showed pathological rearrangement of cerebrovascular networks in the cortex and striatum is associated with poor neuronal restoration leading to worsened cognitive deficits in diabetes. However, little is known about the effect of diabetes on vascular architecture of hippocampus, a domain critical to memory and learning. We hypothesized that diabetes would mediate vasoneuronal remodeling and exacerbate post-stroke deficits in hippocampal tasks. Diabetes was induced by a high fat diet and low dose STZ in male Wistar rats. Cognition was assessed for 2 weeks after stroke (90-min middle cerebral artery occlusion MCAO) by Novel Object Recognition (NOR) and Placement (NPR), Y-Maze and Social Recognition tests. Vasoneuronal architecture and integrity were assessed by measurement of surface area, branch density, IgG extravasation, neuron counts and aquaporin4 (AQP4) polarity for astrocytic endfeet remodeling in dentate gyrus. Diabetes alone increased BBB permeability and unpolarized AQP4, which were exacerbated after MCAO. Post-stroke branch density was higher in control but lower in diabetic rats. While lower baseline hippocampal neuron counts in diabetes was not further reduced after MCAO, poor baseline cognitive and social performance deteriorated. These results suggest that remote ischemic injury can induce profound vasoglial remodeling in the hippocampus and worsens functional outcomes without reducing neurons. Understanding how diabetes impacts post-stroke neurovascular recovery in hippocampus may provide critical insight to worsened cognitive outcomes in this population.
Abstract WP44: Comparison of Multi-modal CT Imaging Protocols Used for Decision-Making on Endovascular Treatment in Patients With Acute Ischemic Stroke
Authors: Khumtong Rujimas , Krings Timo , Pereira Vitor M , Pikula Aleksandra , Schaafsma Joanna D
Published: October 2018

Introduction:
Several CT-based imaging protocols are being used to decide on endovascular treatment (EVT) in acute ischemic stroke. Multiple scans provide extra information but expose patients to additional radiation and/or contrast. We aimed to assess the added value of a delayed phase CTA (dCTA) and CT perfusion (CTP) to non-contrast enhanced CT (NCCT) with arterial phase CTA (aCTA) by comparing treatment decisions based on five commonly used imaging protocols.

Methods:
We retrospectively included consecutive acute ischemic stroke patients who had a symptomatic intracranial arterial occlusion between January 2015 and November 2016 and underwent NCCT, aCTA, dCTA, and CTP. The imaging studies were grouped into five protocols: 1) NCCT and aCTA, 2) NCCT, aCTA, and CTP, 3) NCCT, aCTA, dCTA, 4) NCCT, aCTA, dCTA, and CTP, and 5) NCCT and dCTA. Two interventional neuro radiologists independently decided on the indication for EVT for each patient based on these imaging protocols in a blinded fashion. They reached consensus for discrepant decisions. We assessed the inter-rater agreement using kappa statistics, the rater’s level of confidence, followed by comparison of treatment decisions for the different imaging protocols using McNemar’s test.

Results:
We included 73 patients (44% male, mean age 74). The inter-rater agreement was higher for protocols with three or more modalities (κ= 0.613-0.704) compared to two-modality protocols (κ=0.506-0.529). The highest inter-rater agreement and level of confidence was achieved for the combination of NCCT, aCTA, and CTP. Adding CTP to NCCT and aCTA resulted in a 10% increase and adding dCTA in a 4% increase in the number of patients being offered EVT. These changes in management did not reach statistical significance (p=0.065 and p=0.25 respectively).

Conclusion:
Based on these results, adding CTP and/or a delayed phase CTA to NCCT with arterial phase CTA can assist in better patient selection for EVT in acute ischemic stroke, even though it may not significantly change management.
Abstract WP59: A Clot Burden Score Predicts Functional Outcome and Neurological Complications After Cerebral Venous Sinus Thrombosis
Authors: Shaban Amir , Samaniego Edgar , Aksan Nazan , Dai Biyue , Ahmed Uzair , Granchi Julia , Zheng-Lin Binbin , Lazarre Lara , Adams Harold , Derdeyn Colin , Leira Enrique , Ortega-Gutierrez Santiago
Published: October 2018

Background and purpose:
Involvement of deep venous structures is associated with worse outcomes in patients with cerebral venous sinus thrombosis (CVST); however, the impact of clot burden has not been studied. The aim of this study was to assess the value of a novel quantitative clot burden score as an independent predictor of clinical outcomes.

Methods:
We retrospectively reviewed all patients admitted to University of Iowa Health Care with CVST between 2004-2014. All patients received standard of care medical management per AHA/ASA recommendations. The degree of the thrombosis was categorized in admission MR venograms as (partial=1 vs. complete occlusion=2). Clot burden scores were computed as the sum of the thrombosis degree in the following vessels: cerebral veins (cortical veins, internal cerebral, vein of Rosenthal, vein of Galen) and cerebral sinuses (superior sagittal, inferior sagittal, straight, torcula, transverse/sigmoid). The primary outcome was modified Rankin Scale (mRS) at discharge. Secondary outcomes included hemorrhage, infarction, and cerebral edema. Multiple regressions were conducted to examine effects of clot burden scores on each of the four outcomes.

Results:
115 patients met inclusion criteria, 76 women, and mean age 42. Thrombosis in cerebral veins area was noted in 58(50%), clot burden score Median=4, IQR=2; while 108(96%) had thrombosis in the cerebral sinuses area, Median=4, IQR=5. Clot burden in cerebral veins (p=.005) but not in cerebral sinuses, was associated with worse discharge mRS, r= .22. This effect remained significant when adjusting for age and gender (p=.002), but not when adjusting for complications including ICH, infarct, edema. Importantly, higher clot burden score in the cerebral veins predicted ICH (OR=1.73, p<.001), infarct size (OR=1.66, p<.001), and edema (OR=1.71, p<.001).

Conclusion:
Quantitative clot burden measurement of the cerebral veins conveys additional prediction on outcomes of CVST. Our findings suggest that the worse clinical outcomes associated with clot burden in the cerebral veins may be mediated by ICH, infarct size, and/or edema. The structural differences between the cerebral veins and sinuses may play a role in the variability in clinical outcomes among patients with CVST.
Abstract WP6: Predictors of Acute Neurological Worsening in Ischemic Stroke After Endovascular Thrombectomy
Authors: Soomro Jazba , Zhu Liang , Sarraj Amrou
Published: October 2018

Background:
EVT is effective in AIS with LVO. Successful reperfusion is an integral factor that correlates strongly with good outcome. However, radiographic reperfusion does not always translate into good clinical outcomes. Reasons for poor outcome are thought to be multiple, such as progression of the stroke, and procedural complications - hemorrhagic conversion, vessel dissection, distal emboli, re-occlusion. Data on patients doing poorly in acute phase after EVT is limited.

Objective:
We studied the predictors of neurological worsening after EVT.

Methods:
Retrospective cohort from a single center. AIS patients with LVO in anterior/posterior circulation presented between December 2014 and May 2017 and received EVT. Primary outcome was 1) neurological worsening as change in NIHSS >4 from baseline after EVT in first 24 hours. 2) no improvement in NIHSS post EVT. Univariate and multivariate analysis evaluated clinical and radiographic variables independently correlating with neurological worsening after EVT.

Results:
181 patients included, 21 (11.6%) met the criteria of neurological worsening. Mean age 61 (26-89), Baseline NIHSS 19 (5-35), ASPECT 7 (4-10), Systolic Blood Pressure (SBP) 152 (94-287), Blood Glucose 141 (69-433). The most common causes for worsening were progression of the stroke (38%) and reperfusion injury PH-2 (33%). Using univariate analysis DM (OR 5.21 CI 2.0 to 13.5;
p
0.001), hyperlipidemia (HLD) (OR 4.99 CI 1.83 to 13.62;
p
0.007), BG (OR 1.008 CI 1.0 to 1.15
p
0.009), SBP (OR 1.01 CI 1.0 to 1.0;
p
0.04) were predictors of neurological worsening. In multivariate analysis, only HLD (OR 3.93 CI 1.3 to 11.7
p
0.01) was independent predictor. While admission BG, SBP, NIHSS showed trend towards statistical significance. Strong association between neurological worsening and poor outcome at discharge (MRS 4-6),
p
<0.0001 by Fisher’s test seen.

Conclusion:
Our results are limited by small sample size. It showed that admission BP >150, BG, history of DM and HLD correlated with neurological worsening after EVT. HLD was an independent predictor. This puts emphasis on the importance to control these modifiable factors in EVT treated LVO patients. This also helps us identify which patients might worsen after EVT and how we can optimize this treatment.
Abstract WP79: Surgical Clipping of Recurrent Previously Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 70 Patients
Authors: Nielsen Troels H , Liu Jonathan , Han Summer , Marks Michael , Do Huy , Dodd Robert , Steinberg Gary
Published: October 2018

Introduction:
A paradigm shift in the management of intracerebral aneurysms occurred after the favorable outcomes of coiling were established. Over time, coiled aneurysms have shown high recurrence rates requiring retreatment.

Methods:
We conducted a retrospective study of all patients who underwent surgical clipping of a previously coiled recurrent intracerebral aneurysm between 1997 and 2017 at our institution.

Results:
70 patients met the inclusion criteria. Mean age was 56.4 years (range, 28-77 years), and 40% were male. 61 patients (87%) initially presented with subarachnoid hemorrhage. The mean aneurysm size before clipping was 10.9mm. The average number of endovascular procedures prior to clipping was 1.13 (range 1-3). Indications for clipping included coil compaction in 40%, growing aneurysm base from partially coiled aneurysms in 50%, daughter sac formation in 4%, refilling of the dome in 1.4%, and rebleed in 4%. Coils were extracted in 6 patients (8.6%). Among the 57 patients with post-operative angiograms, 49 aneurysms (86%) showed complete angiographic obliteration, whereas 8 aneurysms (14%) demonstrated small post-clipping residuals. 7.1% of patients sustained minor complications. 3 patients had small clinical strokes that resolved within 2 months, 1 cranial nerve palsy, and 1 infected bone flap. 5.7% of patients suffered a major complication including 2 with severe strokes leading to withdrawal of care, 1 with significant strokes leading to poor functional status, and 1 extraaxial hematoma requiring evacuation. In univariate analyses, the risk of having post-clipping residual was associated with larger aneurysm size (p=0.04) and increased number of prior endovascular procedures (p=0.020). Coil extraction was associated with a greater risk of postoperative complications (p=0.027).

Conclusion:
In conclusion, surgical clipping is an effective therapy for the treatment of recurrent coiled aneurysms, that carries a 5.7% risk of major complications. Further studies should compare the incidence of aneurysm obliteration, rebleed, and complications between clipping versus additional endovascular treatment for these challenging aneurysms.
Abstract WP8: Global Real World Evidence of Balloon Guided Stent Retriever Thrombectomy
Authors: Bozorgchami Hormozd , Priest Ryan , Veznedaroglu Erol , Liebeskind David , Budzik Ronald , Baxter Blaise , Bartolini Bruno , Shields Ryan , Krajina Antonin , Sarraj Amrou , Gupta Rishi , Nogueira Raul , Malek Ali , English Joey ,   Trevo Retriever Registry Investigators, Horikawa Masahiro
Published: October 2018

Background and Aims:
Balloon Guide Catheter (BGC) use during thrombectomy treatment in Stroke patients has been reported to have positive effects on revascularization, procedural characteristics, and clinical outcomes. We evaluate the use of BGC in an open-label large prospective TREVO Retriever Registry of real world patients to determine predictors of good ‘clinical’ outcomes.

Method:
Consecutive Trevo Registry patients that had Balloon Guide Catheter (BGC) used during their thrombectomy procedure were identified; a subset of patients who fulfilled the criteria (ICA and/or MCA-M1/M2 occlusion with pre-morbid mRS 0-1, TLSW ≤6 hrs) within the cohort were also identified. Multivariate analysis was performed to identify the predictors of good outcomes in BGC thrombectomy patients.

Results:
A total of 1031 BGC treated Trevo Registry patients (overall enrolled, n=2010) qualified for analysis, of which 605 patients fulfilling the subset criteria were identified. The mean age of BGC/stent retriever patients was 67.5 with a median (IQR) baseline NIHSS of 15(11-19). Occlusion location of the BCG group was ICA -20.4%, M1- 57.1%, M2/M3-20.3%, and Posterior 1.8%.

In the overall BGC cohort, the median (IQR) time to treatment was (4.2 (3.0,6.5)- hrs.) with conscious/local sedation used in 63.4% and general anesthesia used in 37.3% of cases. The median number of passes with Trevo stent retriever was 1 and revascularization (mTICI ≥ b) was achieved in 92.8% of cases. The sICH rate was low at 1.9% (20/1031) with a low rate of vessel perforation (0.2%). At 90 days post stroke, 56.0% of patients achieved functional independence (mRS 0-2) with 63.7% of the subset of “guidline “ BGC patients achieving functional independence at 90 days. Multivariate logistic regression showed age (aOR 0.97 [0.96, 0.99] P <0.001), Diabetes (aOR 0.67, [0.18,0.98] P =0.03), conscious sedation vs general anesthesia ( aOR 1.7 [1.2,2.3], P= 0.002, number of passes (aOR 0.76 [0.66-0.88],P <0.001), pre stroke mRS (aOR 0.54 [0.45-0.65], P <0.0010 and NIHSS (aOR 0.93 [0.91-0.95], P <0.001) as predictors of functional independence .

Conclusion:
Data from Trevo Registry demonstrate the use of BGC in thrombectomy procedure is safe, and leads to a reduction of disability in ischemic stroke patients.
Abstract WP88: In a Pro-inflammatory Environment, Mesenchymal Stromal Cells Exert Anti-inflammatory and Pro-angiogenic Effects on Endothelial Cells
Authors: Giridhar Kaavya , Satani Nikunj , Yang Bing , Lee Songmi , Xi Xiaopei , Aronowski Jaroslaw , Savitz Sean I
Published: October 2018

Background:
Cell-based therapies such as mesenchymal stromal cells (MSCs) have increasingly shown great promise for ischemic stroke recovery. An understudied target of MSCs may be endothelial cells (ECs). Our study explored the interactions between MSCs and ECs and how this interaction alters EC functionality when exposed to an inflammatory cell stimulus.

Methods:
Primary brain ECs were isolated from postnatal 1-4 day old C57BL/6 mice. Primary MSCs were isolated from the bone marrow of C57BL/6 mice. At passage 3, both the primary cells were individually seeded at 50,000 cells per well. To simulate a stroke-like inflammatory environment, we exposed MSCs and ECs to Lipopolysaccharides (LPS) (doses ranging from 0.01ug/ml to 100ug/ml). 24 hours post-LPS exposure, conditioned media from MSCs was collected and added to the treated ECs. At 24 hours of incubation, media was collected from the ECs and IL-6 and VEGF concentrations were measured using ELISA. Viability of ECs following LPS exposure was measured using MTT assay.

Results:
Treatment of the ECs using MSC conditioned media significantly reduced the release of IL-6, a pro-inflammatory cytokine at dose ranges of 1ug/ml to 100ug/ml of LPS (Fig. 1A-B). The release of VEGF, a pro-angiogenic cytokine, was significantly increased (Fig. 1C-D). There was no significant change in viability of ECs following different LPS doses (data not shown).

Conclusion:
MSCs may release soluble factors that modulate the responses of endothelial cells. MSCs exert anti-inflammatory and pro-angiogeneic effects on ECs in a pro-inflammatory setting. These results identify new targets to better understand how MSCs improve recovery in stroke animal models.
Mechanisms for Wind Direction Changes in the Very Stable Boundary Layer
Authors: Finn D. , Eckman R. M. , Gao Z. , Liu H.
Published: October 2018

Large, rapid, and intermittent changes in wind direction were commonly observed in low–wind speed conditions in the very stable boundary layer during the phase 2 of the Project Sagebrush field tracer study. This paper investigates the occurrence and magnitude of these wind direction changes in the very stable boundary layer and explores their associated meteorological factors. The evidence indicates that these wind direction changes occur mainly at wind speeds of less than 1.5 m s−1 and are associated with momentum and sensible heat fluxes approaching zero in low–wind shear conditions. This results in complete vertical decoupling. They are only weakly dependent on the magnitude of turbulence. The magnitude of the wind direction changes is generally greatest near the surface, because of the greater prevalence of low wind speeds there, and decreases upward.
Subordinate Activation Tactics: Semi-professionals and Micro-level Institutional Change in Professional Organizations
Authors: Kellogg Katherine C.
Published: October 2018

This two-year ethnographic study of the primary care departments in two U.S. hospitals examines how managers can bring about micro-level institutional change in professional practice even when such change challenges professionals’ specialized expertise, autonomy, individual responsibility, and engagement in complex work, which previous research has shown to create difficulties. In this study, managers in both hospitals attempted to implement the same patient-centered medical home (PCMH) reforms among doctors, had the same external pressures for micro-level institutional change, worked under the same organizational and reimbursement structure, and had the same contextual facilitators of micro-level institutional change present within their organizations. But managers in one hospital successfully accomplished change in professional practice while those in the other did not. I demonstrate that managers can accomplish micro-level institutional change in professional organizations using “subordinate activation tactics”—first empowering and motivating subordinate semi-professionals to activate their favorable structural position vis-à-vis the targeted professionals on behalf of managers and next giving semi-professionals positional tools to use in their daily work to minimize the targeted professionals’ concerns about the threats associated with change.
Seasonal Concentration Decomposition of Cruise Tourism Demand in Southern Europe
Authors: Fernández-Morales Antonio , Cisneros-Martínez José David
Published: October 2018

This article analyzes cruise tourism seasonality in Southern Europe, assessing the seasonal concentration levels by means of the Gini index. The additive decomposition of this index is used to evaluate the contribution of each port to the global seasonal concentration in the regions where they are located. It also allows the estimation of marginal relative effects to identify the most propitious ports for reducing seasonality within the Mediterranean regions. The analysis is complemented by estimating the seasonal patterns of each port. Given the significant heterogeneity revealed in the regions analyzed, a bootstrapped bagged clustering is applied to classify the ports into homogeneous groups according to their seasonal patterns. The techniques used form a methodological framework that serves as a control and monitoring tool for measuring seasonal concentration levels in cruise tourism, allowing for policies against seasonality to be tailored for this segment.
Faroese children’s early vocabulary acquisition: A Faroese adaptation of the MacArthur–Bates Communicative Development Inventories
Authors: Rasmussen Sissal M. , Bleses Dorthe
Published: October 2018

The focus of this article is Faroese children’s early vocabulary acquisition using a Faroese adaptation of the MacArthur–Bates Communicative Development Inventories (MBCDI) parental report. The study is a population-based cross-sectional study including 1135 children aged 8–36 months. The article has two objectives: the first is to describe the Faroese adaptation of the MBCDI, and the second is to examine Faroese children’s early vocabulary acquisition. Selected percentile levels for vocabulary comprehension and production are presented, as well as gender differences and developmental trends. The study finds evidence for a spurt in productive vocabulary in the second year of life, and that vocabulary comprehension preceded production, with both showing increases with age similar to those described in the literature for other languages. Girls had an advantage in vocabulary production over boys, resulting in a significant gender difference. Finally, the early lexical composition of Faroese children is notable in that it contains a substantial number of baby-word forms.
Introduction to the Special Issue on Cognitive and Behavioral Flexibility in Fear and Anxiety Disorders
Authors: Boisseau Christina L. , Garnaat Sarah L.
Published: October 2018

Converging lines of research highlight the significance of cognitive and behavioral flexibility in the etiology, maintenance, and treatment of fear and anxiety disorders. We have developed a Special Issue to highlight recent empirical investigations, contemporary theory, and novel directions for future study. It is hoped that this special issue will (a) underscore the centrality of cognitive and behavioral flexibility to fear- and anxiety-related psychopathology, (b) call attention to cognitive science approaches investigating related neuropsychological correlates, and (c) highlight novel experimental and theoretical research on germane contextual factors.
Friends in High Places
Authors: van Troost Dunya , Klandermans Bert , van Stekelenburg Jacquelien
Published: October 2018

Scholars working from the political opportunity approach have upheld the notion that the political context sets the grievances around which activist mobilizes. Inspired by Tarrow and colleagues plea to explain political activism by analyzing how activists are mobilized, this article focuses on the individual protester. The research question in this article reads how are activist’s protest emotions shaped by characteristics of the political context, specifically by their political alliances? We focus on the emotional constellation evoked by environmental issues (e.g., climate change and nuclear energy) with Green Parties as movement allies and anti-austerity issues with Social Democratic parties as movement allies. Specifically, the parliamentary position of these allies is linked to the relative stake anger and frustration have within the emotional constellation of demonstrators. Results are based on survey data collected among 6,598 demonstrators, and their emotions dispersed over 28 demonstrations in seven European countries. We conclude that having a politically well-connected friend seems to matter more to demonstrators’ emotional constellation than the ideological support provided by that friend.
Popular politics in 2 Henry VI: Everyday forms of resistance and hidden transcripts
Authors: Doh In-Hwan
Published: October 2018

This essay aims to re-evaluate popular politics in 2 Henry VI by adopting James Scott’s concepts of hidden transcripts and everyday forms of resistance as its critical methodology. Shakespearean popular politics is invested not only in the scenes punctuated by the high moment of Cade’s rebellion but also in the scenes which register less spectacular forms of resistance, such as the three scenes concerning petitioners, protesters and pirates. Moreover, Scott’s hidden transcripts invite us to reconstruct the Cade scenes so obviously distorted by Elizabethan censorship and to look for the people’s grievances concealed beneath the surface of their disfigured portraits.
Coming to a head: Ragozine as pirate money in Act 4 Scene 3 of Shakespeare’s Measure for Measure
Authors: Crunelle-Vanrigh Anny
Published: October 2018

When the Friar’s plan to have Barnardine beheaded instead of Claudio fails in Act 4 Scene 3 of Measure for Measure, bringing the play’s regime of substitution to a halt, the dead body of ‘One Ragozine, a most notorious pirate’ (4.3.70) opportunely supplies the much-needed head. On this occasion, the play moves away from the earlier barter trade typified by the bed trick to engage in (counterfeit) money economy. A combination of piracy, coining and debasement inaugurates a new regime of economic exchange as an extensive network of metaphors turns the head of the dead pirate into an instance of counterfeit currency, clipped, shaved and coloured according to the debasement practices of the early modern period.
‘Which is the stranger here?’ – Degrees of doubleness, hospitality, and invisibility in The Merchant of Venice
Authors: Orkin Martin
Published: October 2018

Certain critical works and productions, before and after World War II, have foregrounded The Merchant of Venice’s animosity to the Jews and its replication of the myth of the blood libel. Starting from Philip Roth’s meditations on the doubleness of identity, this article explores a ‘hosting’ of Shylock that may be approached through Derridean notions of ‘hospitality’. It then moves on to consider the silence regarding data on early modern Venetian Jews and Jewish theology. What could be termed one of Shakespeare’s most uncanny hate plays continues to pose complex problems of reception in criticism and on contemporary stages.
A Brief Introduction to Antibody–Drug Conjugates for Toxicologic Pathologists
Authors: Mecklenburg Lars
Published: October 2018

Antibody–drug conjugates (ADCs) are an emerging class of anticancer therapeutics, delivering highly cytotoxic molecules directly to cancer cells. ADCs are composed of an antibody, a small molecule drug, and a linker attaching one to another. Antibodies are directed to a large variety of antigens overexpressed on tumor cells, tumor vasculature, or tumor-supporting stroma. After internalization, the ADC is transferred to lysosomes where the cytotoxic component is released, finally killing the target cell. All ADCs are administered via intravenous injection. Once in the circulation, linker stability in plasma is of high importance. In vivo studies in animals address the release of payload over time and typically measure total antibody, conjugated ADC, and free drug. ADC development is driven by ICH (International Council for Harmonisation) guidelines S6(R1) and S9. Dose-limiting toxicities of current ADCs are mainly associated with the payload and correlate well between clinical trials and nonclinical studies in rodents and nonrodents. This mini review is intended to provide general information about ADCs in oncology and shall assist the toxicologic pathologist in correctly interpreting morphological findings acquired in toxicity studies with this entity.
Effects of word boxes on phoneme segmentation, word identification, and spelling for a sample of children with autism
Authors: Joseph Laurice M
Published: October 2018

The purpose of this study was to examine the effects of word boxes on the phoneme segmentation, word identification, and spelling performance of a sample of children with autism. Three children with autism were selected on the basis of similar performance on early literacy skills as measured by the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) screening instrument. The word boxes is a method that involves students placing plastic letters into respective divided sections of a drawn rectangle (i.e., boxes) as each sound in a word is articulated. This method is designed to help children acquire phonological decoding skills. A multiple baseline design across literacy skills was employed to study the effects of word boxes on phoneme segmentation, word identification, and spelling. This study is important, as it was the first to examine the effects of this method with students with autism. Results suggested that all students showed increases in phoneme segmentation and word identification, with two of the students showing some improvement in spelling. Limitations and implications for future research and practice are discussed.
Risk factors related to unnecessary emergency medical services transport for pediatric patients
Authors: Kang Eun Jin , Kim Sun Hyu
Published: October 2018

Objectives

This study evaluated unnecessary emergency medical services (EMS) transport for pediatric patients depending on whether they received emergency department (ED) treatment after EMS transport.

Methods

Pediatric patients were divided into two groups according to whether they received treatment at the ED (ED treatment) or did not receive treatment at the ED (non-ED treatment).

Results

The non-ED treatment group comprised 65 of the total 794 patients. The elapsed time from scene to arrival at the ED was longer in the non-ED treatment group than in the ED treatment group. Weekdays as the days of EMS transport, ground falls rather than traffic accidents as the reason for non-disease-related symptoms, and no immobilization for prehospital treatment were risk factors for non-ED treatment in EMS-transported patients. Causes of not receiving ED treatment for the non-ED treatment group were the patient’s or caregiver’s decision (12%) and the doctor’s suggestion (88%).

Conclusions

Weekdays rather than weekends, ground falls rather than traffic accidents, and no immobilization before hospital are risk factors for not receiving ED treatment. The most common cause of not receiving ED treatment is the doctor’s suggestion.
Of mosses and men: Plant succession, soil development and soil carbon accretion in the sub-Arctic volcanic landscape of Hekla, Iceland
Authors: Vilmundardóttir Olga Kolbrún , Sigurmundsson Friðþór Sófus , Møller Pedersen Gro Birkefeldt , Belart Joaquín Muñoz-Cobo , Kizel Fadi , Falco Nicola , Benediktsson Jón Atli , Gísladóttir Guðrún
Published: October 2018

Lava flows pose a hazard in volcanic environments and reset ecosystem development. A succession of dated lava flows provides the possibility to estimate the direction and rates of ecosystem development and can be used to predict future development. We examine plant succession, soil development and soil carbon (C) accretion on the historical (post 874 AD) lava flows formed by the Hekla volcano in south Iceland. Vegetation and soil measurements were conducted all around the volcano reflecting the diverse vegetation communities on the lavas, climatic conditions around Hekla mountain and various intensities in deposition of loose material. Multivariate analysis was used to identify groups with similar vegetation composition and patterns in the vegetation. The association of vegetation and soil parameters with lava age, mean annual temperature, mean annual precipitation and soil accumulation rate (SAR) was analysed. Soil carbon concentration increased with increasing lava age becoming comparable to concentrations found on the prehistoric lavas. The combination of a sub-Arctic climate, gradual soil thickening due to input of loose material and the specific properties of volcanic soils allow for continuing accumulation of soil carbon in the soil profile. Four successional stages were identified: initial colonization and cover coalescence (ICC) of Racomitrium lanuginosum and Stereocaulon spp. (lavas <70 years of age); secondary colonization (SC) – R. lanuginosum dominance (170−700 years); vascular plant dominance (VPD) (>600 years); and highland conditions/retrogression (H/R) by tephra deposition (70−860 years). The long time span of the SC stage indicates arrested development by the thick R. lanuginosum moss mat. The progression from SC into VPD was linked to age of the lava flows and soil depth, which was significantly deeper within the VPD stage. Birch was growing on lavas over 600 years old indicating the development towards birch woodland, the climax ecosystem in Iceland.
Administrative ethics: Good intentions, bad decisions
Authors: Byrne Joseph M.
Published: October 2018

The Canadian healthcare system is costly. Each day, health leaders must make decisions about what healthcare services will be offered, how they will be funded, to whom they will be made available, and within what administrative and clinical structure they will be managed and delivered. These decisions, their justification, and the ethics framework employed can vary greatly across the Canadian landscape. These high-stakes decisions must not only draw upon healthcare science but the science of business finance, risk management, and organizational design. However, in equal measure and often overlooked, these decisions must draw upon our values, upon our ethics. Sometimes we get it right, and other times, decidedly less so. When timely and fair access to effective and efficient healthcare services is not rendered, matters of justice, fairness, rights, and a host of other constructs are often cited. However, these important constructs are commonly misunderstood, contributing, in part, to well-intentioned but ultimately unethical decisions.
The Impact of Chronic Ozone and Particulate Air Pollution on Mortality in Patients With Sepsis Across the United States
Authors: Rush Barret , Wiskar Katie , Fruhstorfer Clark , Celi Leo Anthony , Walley Keith R.
Published: October 2018

Objective:

The impact of chronic exposure to air pollution on mortality in patients with sepsis is unknown. We attempted to quantify the relationship between air pollution, notably excess ozone, and particulate matter (PM), with in-hospital mortality in patients with sepsis nationwide.

Methods:

The 2011 Nationwide Inpatient Sample (NIS) was linked with ambient air pollution data from the Environmental Protection Agency for both 8-hour ozone exposure and annual mean 2.5-micron PM (PM2.5) pollution levels. A validated severity of illness model for sepsis using administrative data was used to control for sepsis severity.

Results:

The records of 8 023 590 hospital admissions from the 2011 NIS sample were analyzed. Of these, there were 444 928 patients who met the Angus definition of sepsis, treated in hospitals for which air pollution data were available. The cohort had an overall mortality of 11.2%. After adjustment for severity of sepsis, increasing exposure to ozone pollution was associated with increased risk of mortality (odds ratio [OR]: 1.04 for each 0.01 ppm increase, 95% confidence interval [CI]: 1.03-1.05; P < .01). Particulate matter was not associated with mortality (OR: 0.99 for each 5 µg/m3 increase, 95% CI: 0.97-1.01; P = .28). When stratified by sepsis source, ozone pollution had a higher impact on patients with pneumonia (OR: 1.06, 95% CI: 1.04-1.08; P < .01) compared to those patients without pneumonia (OR: 1.02, 95% CI: 1.01-1.03; P < .01).

Conclusion:

Exposure to increased levels of ozone but not particulate air pollution was associated with higher risk of mortality in patients with sepsis. This association was strongest in patients with pneumonia but persisted in all sources of sepsis. Further work is needed to understand the relationship between ambient ozone air pollution and sepsis outcomes.
Development of a real-time steering system model for driving simulators
Authors: Certosini Cesare , Vinattieri Francesco , Capitani Renzo , Annicchiarico Claudio
Published: October 2018

Driving simulators have boosted the vehicle design with the introduction of human beings in the simulation loop. For a realistic functioning, the steering system must provide an accurate behaviour, since the hand wheel is a crucial human interface. Despite a large diffusion of steering models, this paper deals with the creation of a specific solution for real-time applications, characterized by precise features as numerical stability and low computational cost. The proposed model is based on a physical structure and considers all the key phenomena, such as the system elasticities, the power steering effects and friction hysteresis, making the model more accurate in terms of steering wheel torque and lateral acceleration than other angle-driven models. Its two degrees of freedom design allows a proper behaviour of the power steering sub-model; another key aspect is the friction model: the use of the LuGre formulation greatly improves accuracy and stability in comparison to the lookup table friction models. Compared to the literature reference torque-driven model, it does not need the use of a torque sensor when implemented in driving simulators having an angle-driven formulation (the input of the steering wheel is its angle and the torque needed is its output), hence it is cheaper to implement; nevertheless, its accuracy is close to state-of-art reference. An original parametrization procedure is proposed since a generalized one is not available in literature; using a steering test-rig, all the model variables are defined. The validation phase combines offline and online simulations, assessing objectively and subjectively the model’s capabilities and showing accurate results in terms of steering wheel torque, lateral acceleration and steering feeling. In addition, a minor contribution of this paper shows how different analyses (steering effort evaluation, experimental data comparison or simulator feedback computation) require different output torques.
The Power of Attention: Using Eye Gaze to Predict Other-Regarding and Moral Choices
Authors: Ghaffari Minou , Fiedler Susann
Published: October 2018

According to research studying the processes underlying decisions, a two-channel mechanism connects attention and choices: top-down and bottom-up processes. To identify the magnitude of each channel, we exogenously varied information intake by systematically interrupting participants’ decision processes in Study 1 ( N = 116). Results showed that participants were more likely to choose a predetermined target option. Because selection effects limited the interpretation of the results, we used a sequential-presentation paradigm in Study 2 (preregistered, N = 100). To partial out bottom-up effects of attention on choices, in particular, we presented alternatives by mirroring the gaze patterns of autonomous decision makers. Results revealed that final fixations successfully predicted choices when experimentally manipulated (bottom up). Specifically, up to 11.32% of the link between attention and choices is driven by exogenously guided attention (1.19% change in choices overall), while the remaining variance is explained by top-down preference formation.
Adaptive non-inferiority margins under observable non-constancy
Authors: Hanscom Brett , Hughes James P , Williamson Brian D , Donnell Deborah
Published: October 2018

A central assumption in the design and conduct of non-inferiority trials is that the active-control therapy will have the same degree of effectiveness in the planned non-inferiority trial as in the prior placebo-controlled trials used to define the non-inferiority margin. This is referred to as the ‘constancy’ assumption. If the constancy assumption fails, decisions based on the chosen non-inferiority margin may be incorrect, and the study runs the risk of approving an inferior product or failing to approve a beneficial product. The constancy assumption cannot be validated in a trial without a placebo arm, and it is unlikely ever to be met completely. When there are strong, observable predictors of constancy, such as dosing and adherence to the active-control product, we can specify conditions where the constancy assumption will likely fail. We propose a method for using measurable predictors of active-control effectiveness to specify non-inferiority margins targeted to the planned study population characteristics. We describe a pre-specified method, using baseline characteristics or post-baseline predictors in the active-control arm, to adapt the non-inferiority margin at the end of the study if constancy is violated. Adaptive margins can help adjust for constancy violations that will inevitably occur in real clinical trials, while maintaining pre-specified levels of Type I error and power.
ICT in Development: A Contextual Approach
Authors: Rafi Kambaiz
Published: October 2018

The importance of information and communication technology (ICT) in economic development is a topic that still raises contention. The view held commonly among global development institutions—the World Bank, UN, The Organisation for Economic Co-operation and Development (OECD) and so on—is that it plays a positive role. Within a new approach to the role of knowledge in economic development, stress is laid on how to bridge the gap between technologically advanced countries (TACs) where ICT use is widespread and less developed countries (LDCs) where shortage or lack of access to it is perceived as an impediment to growth and development. While agreeing, in principle, with a positive viewpoint on ICT in economic development, this essay takes a different approach; it seeks to analyse the contextual adaptations of ICT use rather than its use ipso facto leading to a positive outcome. It is argued that ICT use adapts itself to the socio-organizational design of work in an LDC rather than transforming it. Further, to bring this technological change, a much more hands-on approach in ICT service production and dissemination would be required instead of these countries functioning as mere recipients of arm’s length ICT services.
Unilateral Policies, Competitiveness and the ‘Green Paradox’ in a Dynamic North–South Model
Authors: Sen Partha
Published: October 2018

The effects of a unilateral cut in emissions (e.g., by Annexure 1 countries in Kyoto) are analysed in a dynamic two-country two-commodity model. If the fossil fuel is priced at marginal cost, then a unilateral cut reduces total emissions (the carbon leakage is less than 100%). But if the fuel is priced above marginal cost, then a ‘green paradox’ appears, that is, the price of the fuel will fall until its use (over time) exhausts the entire stock. Here, a unilateral policy is self-defeating and it is necessary to get binding commitments on fossil fuel use from all the countries. The production and trade implications for the participant and non-participant countries are analysed.

JEL: Q4, Q50, Q54, Q56
Why it’s time to focus on masculinity in mental health training and clinical practice
Authors: Seidler Zac E , Rice Simon M , Dhillon Haryana M , Herrman Helen
Published: October 2018

Objective:

Men present with complex, diverse and often contradictory expressions of masculinity that are relevant to their health status. This article argues for the inclusion of masculinity into mental health curricula in Australia. Masculinity mediates health outcomes by influencing help seeking and engagement with treatment.

Conclusion:

An online curricula audit of publicly available information from Australian medical programs and their professional bodies reveals increasing awareness of the needs, but limited practical inclusion of masculinity models in training and practice. Described are the elements essential to training and subsequent clinical practice to curb the poor mental health outcomes of Australian men.