bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of a Cleavage-Resistant Collagen Mutation on Left Ventricular Remodeling
Authors: Lindsey Merry L. , Yoshioka Jun , MacGillivray Catherine , Muangman Suphichaya , Gannon Joseph , Verghese Anjali , Aikawa Masanori , Libby Peter , Krane Stephen M. , Lee Richard T.
Published: July 2003

Matrix metalloproteinase–mediated degradation of type I collagen may play a role in cardiac remodeling after strain or injury. To explore this hypothesis, we used mice homozygous (r/r) for a targeted mutation in
Col1a1
; these mice synthesize collagen I that resists collagenase cleavage at Gly975-Leu976. A total of 64 r/r and 84 littermate wild-type mice (WT) underwent experimental pressure overload by transverse aortic constriction (TAC) or myocardial infarction (MI). Echocardiographic, hemodynamic, and histological parameters were evaluated up to 12 weeks after TAC or 21 days after MI. At 4 weeks after TAC, collagen levels, wall thickness, and echocardiographic parameters were similar in the 2 groups. At 12 weeks after TAC, r/r mice had smaller LV dimensions (ESD: 2.7±0.2 mm WT versus 1.7±0.2 mm r/r,
P
<0.013; EDD: 3.8±0.2 mm WT versus 3.1±0.1 mm r/r,
P
<0.013); better fractional shortening (30±2% WT versus 46±4% r/r;
P
<0.013); and lower LV/body weight ratios (7.3±0.6 WT and 5.1±0.5 r/r;
P
<0.013). Surprisingly, these differences were not accompanied by differences in collagen accumulation, myocyte cross-sectional areas, wall thickness, or microvessel densities. Furthermore, no differences in LV remodeling assessed by echocardiography, fibrosis, or hemodynamic parameters were found between r/r and WT mice after MI. Thus, a mutation that encodes a collagenase cleavage-resistant collagen I does not affect early LV remodeling after TAC or MI, suggesting that collagen cleavage at this site is not the mechanism by which metalloproteinases mediate LV remodeling. Collagen cleavage could, however, have a role in preservation of cardiac function in late remodeling by mechanisms independent of collagen accumulation. We were not able to detect collagen cleavage fragments, and could not, therefore, rule out the possibility of collagen cleavage at additional sites.
Uncoupling Protein-2 Overexpression Inhibits Mitochondrial Death Pathway in Cardiomyocytes
Authors: Teshima Yasushi , Akao Masaharu , Jones Steven P. , Marbán Eduardo
Published: July 2003

Uncoupling proteins (UCPs) are located in the mitochondrial inner membrane and partially dissipate the transmembrane proton electrochemical gradient. UCP2 is expressed in various human and rodent tissues, including the heart, where its functional role is unknown. In the present study, we tested the hypothesis that UCP2 overexpression could protect cardiomyocytes from oxidative stress–induced cell death by reducing reactive oxygen species (ROS) production in mitochondria. Using an adenoviral vector containing human UCP2, we investigated the effects of UCP2 overexpression on the mitochondrial death pathway induced by oxidative stress (100 μmol/L H
2
O
2
) in cultured neonatal cardiomyocytes. UCP2 overexpression significantly suppressed markers of cell death, including TUNEL positivity, phosphatidylserine exposure, propidium iodide uptake, and caspase-3 cleavage. Furthermore, UCP2 remarkably prevented the catastrophic loss of mitochondrial inner membrane potential induced by H
2
O
2
, which is a critical early event in cell death. Ca
2+
overload and the production of ROS in mitochondria, both of which contribute to mitochondrial inner membrane potential loss, were dramatically attenuated by UCP2 overexpression. Thus, overexpression of UCP2 attenuates ROS generation and prevents mitochondrial Ca
2+
overload, revealing a novel mechanism of cardioprotection.
Cause-Specific Mortality After First Cerebral Infarction
Authors: Vernino Steven , Brown Robert D. , Sejvar James J. , Sicks JoRean D. , Petty George W. , O’Fallon W. Michael
Published: July 2003

Background and Purpose—

Mortality after cerebral infarction (CI) has remained unchanged during the past 20 years, despite advances in neurologic care. Key factors affecting survival may be underrecognized. The purpose of this study was to determine the rate and cause of mortality after first CI.

Methods—

In this case-control, population-based study, all available medical records were reviewed for Rochester (Minnesota) residents with a first CI between 1985 and 1989 to identify morbidities and cause of death. Predictors for mortality were analyzed.

Results—

First CI was recorded for 444 patients. Survival was 83% at 1 month, 71% at 1 year, and 46% at 5 years. The most frequent causes of death were cardiovascular events (22%), respiratory infection (21%), and initial stroke complications (14%). Recurrent stroke and cancer accounted for 9% and 7.5% of deaths, respectively. In the first month after CI, 51% of deaths were attributed to the initial CI, 22% to respiratory infections, and 12% to cardiovascular events. During the first year, 26% of deaths resulted from respiratory infections and 28% from cardiovascular disease. Mortality was higher among patients than controls for at least 2 years after CI. Age, cardiac comorbid conditions, CI severity, stroke recurrence, seizures, and respiratory and cardiovascular morbidities were independent predictors of death.

Conclusions—

In the first month after CI, mortality resulted predominantly from neurologic complications. Later mortality remained high because of respiratory and cardiovascular causes. To improve long-term survival after CI, aggressive management of pulmonary and cardiac disease is as important as secondary stroke prevention.
Very Early Risk of Stroke After a First Transient Ischemic Attack
Authors: Lovett J.K. , Dennis M.S. , Sandercock P.A.G. , Bamford J. , Warlow C.P. , Rothwell P.M.
Published: July 2003

Background and Purpose—

The commonly quoted early risks of stroke after a first transient ischemic attack (TIA)—1% to 2% at 7 days and 2% to 4% at 1 month—are likely to be underestimates because of the delay before inclusion into previous studies and the exclusion of patients who had a stroke during this time. Therefore, it is uncertain how urgently TIA patients should be assessed. We used data from the Oxford Community Stroke Project (OCSP) to estimate the very early stroke risk after a TIA and investigated the potential effects of the delays before specialist assessment.

Methods—

All OCSP patients who had a first-ever definite TIA during the study period (n=209) were included. Three analyses were used to estimate the early stroke risk after a first TIA starting from 3 different dates: assessment by a neurologist, referral to the TIA service, and onset of first TIA.

Results—

The stroke risk from assessment by a neurologist was 1.9% [95% confidence interval (CI), 0.1 to 3.8] at 7 days and 4.4% (95% CI, 1.6 to 7.2) at 30 days. The 7- and 30-day stroke risks from referral were 2.4% (95% CI, 0.3 to 4.5) and 4.9% (95% CI, 1.9 to 7.8), respectively, and from onset of first-ever TIA were 8.6% (95% CI, 4.8 to 12.4) and 12.0% (95% CI, 7.6 to 16.4), respectively.

Conclusions—

The early risk of stroke from date of first-ever TIA is likely to be higher than commonly quoted. Public education about the symptoms of TIA is needed so that medical attention is sought more urgently and stroke prevention strategies are implemented sooner.
Ebselen, a Seleno-Organic Antioxidant, Is Neuroprotective After Embolic Strokes in Rabbits
Authors: Lapchak Paul A. , Zivin Justin A.
Published: July 2003

Background and Purpose—

It has been proposed that antioxidants and spin-trap agents may be neuroprotective after acute ischemia stroke. Although the antioxidant ebselen is currently in clinical trials, little is known about the effectiveness of ebselen, which has glutathione peroxidase–like and anti-inflammatory properties in embolic stroke models. Therefore, we determined the effects of ebselen when administered alone or with the thrombolytic tissue plasminogen activator (tPA), the only Food and Drug Administration–approved pharmacological agent for the treatment of stroke.

Methods—

Male New Zealand White rabbits were embolized by injection of a suspension of small blood clots into the middle cerebral artery via a catheter. Five minutes after embolization, ebselen (10 to 50 mg/kg) was infused intravenously. Control rabbits received infusions of the vehicle required to solubilize ebselen. In additional rabbits, ebselen (20 mg/kg) was administered 60 minutes after embolization, either alone or in combination with tPA (0.9 or 3.3 mg/kg tPA). Behavioral analysis was conducted 24 hours after embolization, allowing determination of the effective stroke dose (P
50
) or clot amount (mg) that produces neurological deficits in 50% of the rabbits.

Results—

A drug is considered neuroprotective if it significantly increases the P
50
compared with the vehicle-treated control group. The P
50
of controls 24 hours after embolization was 1.35±0.30 mg. Rabbits treated 5 minutes after embolization with 10, 20, or 50 mg/kg ebselen had P
50
values of 2.12±0.56, 2.82±0.75 (
P
<0.05), and 0.49±0.54 mg, respectively. A significant neuroprotective effect was observed with the 20-mg/kg dose, but not if there was a 60-minute delay before administration (P
50
=1.69±0.32 mg). When tPA (3.3 mg/kg) was infused 60 minutes after embolization and ebselen (20 mg/kg) was injected at either 5 (P
50
=2.98±0.18 mg) or 60 (P
50
=3.60±0.79 mg) minutes, there was no additional neuroprotective effect compared with tPA alone (P
50
=3.38±0.55 mg). However, if ebselen (20 mg/kg) was administered concomitantly with low-dose tPA (0.9 mg/kg) 60 minutes after embolization, the P
50
was 3.52±0.73 mg (
P
<0.05), indicating a synergistic effect of the drug combination because neither alone was effective (P
50
=1.69±0.32 and 1.54±0.36 mg, respectively).

Conclusions—

This study indicates that ebselen may be neuroprotective when administered shortly after an embolic stroke, but the time- and dose-response analyses suggest that it has a narrow therapeutic window. Nevertheless, ebselen may be beneficial if administered concomitantly with a thrombolytic because it significantly enhanced the neuroprotective activity of low-dose tPA.
Are Changes in Mortality From Stroke Caused by Changes in Stroke Event Rates or Case Fatality?
Authors: Sarti Cinzia , Stegmayr Birgitta , Tolonen Hanna , Mähönen Markku , Tuomilehto Jaakko , Asplund Kjell
Published: July 2003

Background and Purpose—

Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality.

Methods—

The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change.

Results—

Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality.

Conclusions—

In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.
Effect of Aging on Dynamic Cerebral Autoregulation During Head-Up Tilt
Authors: Carey Brian J. , Panerai Ronney B. , Potter John F.
Published: July 2003

Background and Purpose—

Physiological aging is associated with many changes in the cardiovascular and cerebrovascular systems, but dynamic cerebral autoregulation (CA) during supine rest shows no age-related changes. Because syncopal syndromes usually occur during orthostatic stress and their prevalence increases with age, it is important to define the effect of aging on dynamic CA during orthostatic stress.

Methods—

Twenty-five younger subjects (≤40 years) and 25 sex-matched older subjects (≥60 years) underwent 70° head-up tilt for 30 minutes. Bilateral middle cerebral artery blood flow velocities were measured with transcranial Doppler ultrasound, along with noninvasive continuous measurements of arterial blood pressure, heart rate, and transcutaneous and end-tidal carbon dioxide concentrations. By comparing actual changes in cerebral blood flow velocity to changes predicted by a model based on arterial blood pressure changes, we derived dynamic autoregulatory indexes for each subject for periods before, during, and after tilt.

Results—

Younger subjects were a mean of 40 years younger than older subjects (28±8 versus 69±10 years). Although cerebral blood flow velocity (
P
<0.001) and baroreceptor sensitivity (
P
<0.001) were significantly lower at rest in older subjects, autoregulatory indexes were similar in younger and older subjects at all times before, during, and after tilt (
P
=0.62).

Conclusions—

Although increasing age is associated with lower cardiac baroreceptor sensitivity and cerebral blood flow velocity, dynamic CA during orthostatic stress is unaffected by physiological aging.
Relative Value of Normalized Sonographic In Vitro Analysis of Arteriosclerotic Plaques of Internal Carotid Artery
Authors: Denzel Christian , Balzer Klaus , Müller Klaus-Michael , Fellner Franz , Fellner Claudia , Lang Werner
Published: July 2003

Background and Purpose—

A close correlation between B-mode sonography and the histopathology and surface structure of plaque is rarely seen in vivo with high-grade stenoses of the extracranial carotid artery. The goal of this study was to determine whether normalized gray scale analysis and surface analysis of the plaque are capable of characterizing the attributes correctly.

Methods—

Optimized B-mode images of 107 carotid endarterectomy specimens were captured, and the gray scale median (GSM) was calculated. The specimens were classified histologically into 3 groups: (1) calcium-rich hard plaques, (2) lipid-rich soft plaques, and (3) combined plaques. The surfaces of the plaques were classified as smooth or rough on the basis of standardized reference samples. The endoluminal surface was digitally documented in vitro by videoendoscopy and again classified into the same categories. All stages of the investigation were performed by 2 observers at 2 different times.

Results—

Evaluation of the GSM showed close interobserver and intraobserver correlation (
P
<0.01,
R
>0.8). However, there was only 46% agreement between the GSM and the histopathological findings. In both in vitro angioscopy (κ=0.936,
P
<0.001) and sonographic evaluation (κ=0.842,
P
<0.001), there was a high correlation between the observers with regard to the evaluable specimens. In 73%, agreement was observed between the sonographic image and angioscopy.

Conclusions—

Normalized gray scale analysis and evaluation of the plaque surface in an in vitro study make possible observer-independent evaluation. The composition of the plaque cannot be visualized with sufficient accuracy by sonographic GSM analysis. This also applies to the correlation between sonography and actual surface composition of the plaque.
Prediction of Malignant Middle Cerebral Artery Infarction by Early Perfusion- and Diffusion-Weighted Magnetic Resonance Imaging
Authors: Thomalla Götz J. , Kucinski Thomas , Schoder Volker , Fiehler Jens , Knab Rene , Zeumer Herrmann , Weiller Cornelius , Röther Joachim
Published: July 2003

Background and Purpose—

We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI).

Methods—

Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient <80% (ADC
<80%
) and time to peak >+4 seconds (TTP
>+4s
) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADC
core
) and relative ADC within the ADC
<80%
lesion (rADC
lesion
) were measured. Neurological deficit at admission was assessed with the National Institutes of Health Stroke Scale (NIHSS).

Results—

Patients with MMI showed larger ADC
<80%
(median, 157 versus 22 mL;
P
<0.001) and TTP
>+4s
(208 versus 125 mL;
P
<0.001) lesion volumes, smaller TTP/ADC mismatch ratio (1.5 versus 5.5;
P
<0.001), lower ADC
core
values (290 versus 411 mm
2
/s;
P
<0.001), lower rADC
lesion
(0.60 versus 0.66;
P
=0.001), higher frequency of carotid-T occlusion (64% versus 15%;
P
=0.006), and higher NIHSS score at admission (20 versus 15;
P
=0.001). Predictors of MMI were as follows for sensitivity and specificity, respectively: ADC
<80%
>82 mL, 87%, 91%; TTP
>+4s
>162 mL, 83%, 75%; TTP/ADC mismatch ratio <2.4, 80%, 79%; ADC
core
<300 mm
2
/s, 83%, 85%; rADC
lesion
<0.62, 79%, 74%; and NIHSS score at admission ≥19, 96%, 72%.

Conclusions—

Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.
Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)
Authors: Hilari Katerina , Byng Sally , Lamping Donna L. , Smith Sarah C.
Published: July 2003

Background and Purpose—

Health-related quality of life (HRQL) is a key outcome in stroke clinical trials. Stroke-specific HRQL scales (eg, SS-QOL, SIS) have generally been developed with samples of stroke survivors that exclude people with aphasia. We adapted the SS-QOL for use with people with aphasia to produce the Stroke and Aphasia Quality of Life Scale (SAQOL). We report results from the psychometric evaluation of the initial 53-item SAQOL and the item-reduced SAQOL-39.

Methods—

We studied 95 people with long-term aphasia to evaluate the acceptability, reliability, and validity of the SAQOL and SAQOL-39 using standard psychometric methods.

Results—

A total of 83 of 95 (87%) were able to complete the SAQOL by self-report; their results are reported here. Results supported the reliability and validity of the overall score on the 53-item SAQOL, but there was little support for hypothesized subdomains. Using factor analysis, we derived a shorter version (SAQOL-39) that identified 4 subdomains (physical, psychosocial, communication, and energy). The SAQOL-39 demonstrated good acceptability, internal consistency (Cronbach’s α=0.74 to 0.94), test-retest reliability (intraclass correlation coefficient=0.89 to 0.98), and construct validity (corrected domain–total correlations,
r
=0.38 to 0.58; convergent,
r
=0.55 to 0.67; discriminant,
r
=0.02 to 0.27 validity).

Conclusions—

The SAQOL-39 is an acceptable, reliable, and valid measure of HRQL in people with long-term aphasia. Further testing is needed to evaluate the responsiveness of the SAQOL-39 and to investigate its usefulness in evaluative research and routine clinical practice.
Cochrane Review: Dipyridamole for Preventing Major Vascular Events in Patients With Vascular Disease
Authors: De Schryver E.L.L.M. , Algra A. , van Gijn J.
Published: July 2003

Background—

Patients enrolled in clinical trials after nondisabling cerebral ischemia have an annual risk of vascular events (death from all vascular causes, nonfatal stroke, or nonfatal myocardial infarction) of 4% to 11%. Aspirin reduces the incidence by 13%. Many trials in patients presenting with vascular disease investigated the efficacy of (addition of) dipyridamole in secondary prevention. We systematically compared the efficacy and safety of dipyridamole versus control in the presence and absence of other antiplatelet drugs in clinical trials on the secondary prevention of vascular events in patients with vascular disease.

Summary of Review—

Randomized trials with concealed treatment allocation in patients with a nonembolic arterial vascular disease were selected. Therapy consisted of dipyridamole in the presence or absence of other antiplatelet drugs compared with no drug or an antiplatelet drug(s) other than dipyridamole. Twenty-six trials were included, with a total of 19 842 patients. Dipyridamole was not more efficacious in the prevention of vascular death (relative risk [RR], 1.02; 95% CI, 0.90 to 1.17). It appeared more efficacious in the prevention of vascular events (RR, 0.90; 95% CI, 0.83 to 0.98), but this result only reached statistical significance because of 1 large trial in patients presenting with cerebral ischemia. Combination treatment of dipyridamole and aspirin compared with aspirin had an RR of 1.03 (95% CI, 0.87 to 1.22) for vascular death and an RR of 0.90 (95% CI, 0.80 to 1.00) for vascular events.

Conclusions—

For patients who presented with arterial vascular disease, there was no evidence that dipyridamole, in the presence or absence of another antiplatelet drug (chiefly aspirin), reduced the risk of vascular death, although it may reduce the risk of further vascular events. However, this benefit was found only in a single large trial and only in patients presenting after cerebral ischemia. There was no evidence that dipyridamole alone was more efficacious than aspirin. Further trials comparing the effects of the combination of dipyridamole plus aspirin with aspirin alone are justified.
Operational Definitions for the NINDS-AIREN Criteria for Vascular Dementia
Authors: van Straaten Elisabeth C.W. , Scheltens Philip , Knol Dirk L. , van Buchem Mark A. , van Dijk Ewout J. , Hofman Paul A.M. , Karas Giorgos , Kjartansson Olafur , de Leeuw Frank-Erik , Prins Niels D. , Schmidt Reinhold , Visser Marieke C. , Weinstein Henry C. , Barkhof Frederik
Published: July 2003

Background and Purpose—

Vascular dementia (VaD) is thought to be the most common cause of dementia after Alzheimer’s disease. The commonly used International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (AIREN) criteria for VaD necessitate evidence of vascular disease on CT or MRI of the brain. The purposes of our study were to operationalize the radiological part of the NINDS-AIREN criteria and to assess the effect of this operationalization on interobserver agreement.

Methods—

Six experienced and 4 inexperienced observers rated a set of 40 MRI studies of patients with clinically suspected VaD twice using the NINDS-AIREN set of radiological criteria. After the first reading session, operational definitions were conceived, which were subsequently used in the second reading session. Interobserver reproducibility was measured by Cohen’s κ.

Results—

Overall agreement at the first reading session was poor (κ=0.29) and improved slightly after application of the additional definitions (κ=0.38). Raters in the experienced group improved their agreement from almost moderate (κ=0.39) to good (0.62). The inexperienced group started out with poor agreement (κ=0.17) and did not improve (κ=0.18). The experienced group improved in both the large- and small-vessel categories, whereas the inexperienced group improved generally in the extensive white matter hyperintensities categories.

Conclusions—

Considerable interobserver variability exists for the assessment of the radiological part of the NINDS-AIREN criteria. Use of operational definitions improves agreement but only for already experienced observers.
Closure of the Blood-Brain Barrier by Matrix Metalloproteinase Inhibition Reduces rtPA-Mediated Mortality in Cerebral Ischemia With Delayed Reperfusion
Authors: Pfefferkorn Thomas , Rosenberg Gary A.
Published: July 2003

Background and Purpose—

Intravenous recombinant tissue plasminogen activator (rtPA) can be beneficial in ischemic stroke despite an increased risk of hemorrhage and potential neurotoxic effects. We hypothesized that rtPA-mediated adverse effects depend on the timing of reperfusion and injury to the blood-brain barrier (BBB).

Methods—

Male Wistar rats had middle cerebral artery occlusion (MCAO) by intraluminal thread placement. Intervals of ischemia/reperfusion, respectively, in hours were 0/18, 1.5/16.5, 3/15, 6/12, 18/0, and 6/1. Animals received either rtPA or saline for 1 hour at the time of reperfusion or, for the 18/0 trial, starting 1 hour after MCAO. Outcome parameters were mortality, matrix metalloproteinase-2 and −9 (MMP-2 and −9) concentrations, tissue hemoglobin, and brain water content. We analyzed the permeability of the BBB by using the brain
14
C[sucrose] uptake method. Effects of the MMP inhibitor BB-94 on the BBB without rtPA treatment and on mortality with rtPA were tested in animals with 6/1 and 6/12, respectively.

Results—

In delayed reperfusion (6/12), rtPA increased mortality from 17% to 83% (
P
<0.01) without significantly affecting other outcome parameters. In 6/1, sucrose uptake in the ischemic hemisphere was markedly increased (8.80±1.14% vs 2.15±0.26%;
P
<0.01). This uptake was reduced by treatment with BB-94 (3.95±1.48%,
P
<0.01). Furthermore, BB-94 reduced rtPA-mediated mortality in 6/12 to 33% (
P
<0.05).

Conclusions—

rtPA-mediated mortality in delayed reperfusion is associated with early opening of the BBB. Closure of the BBB with BB-94 given before rtPA treatment reduced mortality, suggesting that treatment with MMP inhibitors might reduce the risk associated with thrombolysis.
Advertising Strategies to Increase Public Knowledge of the Warning Signs of Stroke
Authors: Silver Frank L. , Rubini Frank , Black Diane , Hodgson Corinne S.
Published: July 2003

Background and Purpose—

Public awareness of the warning signs of stroke is important. As part of an educational campaign using mass media, the Heart and Stroke Foundation of Ontario conducted public opinion polling in 4 communities to track the level of awareness of the warning signs of stroke and to determine the impact of different media strategies.

Methods—

Telephone surveys were conducted among members of the general public in 1 control and 3 test communities before and after mass media campaigns. The main outcome measure used to determine effectiveness of the campaigns was the ability to name ≥2 warning signs of stroke.

Results—

In communities exposed to television advertising, ability to name the warning signs of stroke increased significantly. There was no significant change in the community receiving print (newspaper) advertising, and the control community experienced a decrease. Television increased the knowledge of both men and women and of people with less than a secondary school education but not of those ≥65 years of age. Intermittent, low-level television advertising was as effective as continuous, high-level television advertising.

Conclusions—

Results of this survey can be used to guide mass media–buying strategies for public health education.
Cerebral Ischemia and Infarction From Atheroemboli <100 μm in Size
Authors: Rapp Joseph H. , Pan Xian Mang , Yu Bo , Swanson Raymond A. , Higashida Randall T. , Simpson Paul , Saloner David
Published: July 2003

Background and Purpose—

To determine the importance of emboli not trapped by carotid angioplasty filtration devices, we examined fragments <100 μm released with ex vivo angioplasty and asked if fragment composition and size correlated with brain injury.

Methods—

Human carotid plaques (21) were excised en bloc, and ex vivo carotid angioplasty was performed. Eight plaques were selected as either highly calcified (4) or highly fibrotic (4) by high-resolution MRI (200 μm
3
). Fragments were counted by a Coulter counter. Before injection into male Sprague-Dawley rats, fragments from calcified and fibrotic plaques were sized with 60-, 100-, and 200-μm filters. Brain ischemia and infarction were assessed by MRI scans (7-T small-bore magnet) and by immunohistologic staining for HSP70 and NueN.

Results—

All 5 animals injected with 100- to 200-μm calcified fragments had infarctions. One was lethal. After injection of 60- to 100-μm calcified fragments, 7 of 12 animals had cerebral infarctions, whereas only 1 of 11 had infarctions with fibrous fragments (
P
<0.02). HSP70 staining showed that ischemia was more common and more extensive than infarction. Ischemia was found in 10 of 12 animals after injection of calcified fragments and in 9 of 11 after injection of fibrous fragments. The mean number of 60- to 100-μm fragments released was 375±510; the mean number of 20- to 60-μm fragments was 34 196 (range, 2230 to 186 927).

Conclusions—

Hundreds of thousands of microemboli can be shed during carotid angioplasty. Fragments from calcified plaques cause greater levels of infarction than fragments from fibrous plaques, although ischemia is common with both fragment types.
Sex Differences in Management and Outcome After Stroke
Authors: Glader Eva-Lotta , Stegmayr Birgitta , Norrving Bo , Terént Andreas , Hulter-Åsberg Kerstin , Wester Per-Olov , Asplund Kjell
Published: July 2003

Background and Purpose—

It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective.

Methods—

In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses.

Results—

Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4).

Conclusions—

Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.
Vantages in a Word Field: Variably Distributed Attention to Similarity
Authors: MacLaury Robert
Published: July 2003

Distributed attention to similarity and difference is critical to maintaining relations among categories in a semantic field. And this distribution determines the lower and upper number of such categories, although numbers will differ in accord with selected properties on which the categories are based. The determining constraint is the total amount of attention that a person will normally devote to similarity and difference, which is proposed to be universal. Vantage theory provides the explanatory framework, by which the distribution is actively managed by a person who, as with any system so managed, will perform effectively or dysfunctionally. Occasional aberration suggests that people indeed are involved in their cognitive systems. Vantage theory, too, then models how distributed attention may go amiss.
Situatedness: The Interplay between Context(s) and Situation
Authors: Rohlfing Katharina , Rehm Matthias , Goecke Karl Ulrich
Published: July 2003

In order to interpret the behaviour of cognitive systems, the integration into their specific cultural environment must be considered. The phenomenon of situatedness is a crucial determinant of this behaviour. We derive the notion of situatedness from the interplay between agent, situation, and context (divided into inter- and intracontext). The main objective of this paper is to connect a theoretical analysis of situatedness with its implications for empirical research. In particular, we consider processes of situated learning in natural and artificial systems.
Essentialism, Power and Cultural Psychology of Gender
Authors: Mahalingam Ramaswami , Rodriguez Joel
Published: July 2003

This paper describes the results of our study of folk theories of Americans (N = 147) and Indians (Brahmins, N = 93; Dalits, N = 93), using a brain transplant paradigm. We found significant cultural differences between Americans and Indians (p < .001). The majority of Americans believed that a brain transplant would result in change in gender behavior whereas the majority of Indians, particularly Brahmin males, believed that a brain transplant would change only the gender behavior of men not women. Qualitative analysis of open-ended responses found that American men believed in the computational model of identity, whereas American women believed in the distributed notion of identity. Among Indians, Brahmin males believed in the biological notion of identity more than any other group.
National Constitutions and Human Rights Issues in Africa
Authors: Udogu E. Ike
Published: July 2003

Philosophers such as Socrates, Plato, Aristotle, Hobbes, Locke and Marx, in the European context, and Dubois, Cabral, Fanon, and Ake, in the African political situation investigated and worked on modalities for constructing "the good political life" for human beings in a society with some success in the Occident and limited outcome in Africa. In the latter, the postcolonial period was marked by political competition over the control of the apparatus of power, the problems of human rights and political legitimacy, inter alia. Indeed, provisions were made in the constitution intended to assuage some of these conflictive problems. One such measure was the respect for human rights. The purpose of this essay is to show, concisely, how African governments have not always implemented human rights instruments contained in their constitutions, and to suggest ways that they might, in order to further stability in the area.
Chieftaincy in Ghana: Challenges and Prospects in the 21st Century
Authors: Boafo-Arthur Kwame
Published: July 2003

The paper delineates what is seen as key challenges to the chieftaincy institution in Ghana. Historical challenges in the form of colonial attempts to sidestep the institution and the attempts by the immediate post independence governments to subjugate and divest them of their economic strength through drastic laws, never cowed the institution. Currently, the 1992 Fourth Republic Constitution bars chiefs from participating in partisan politics thus infringing on their inalienable right of free association. The responses of chiefs to current challenges include the setting up of education funds, participating in HIV/AIDS education, and sensitizing the people on the dangers of environmental degradation. In sum, the noted resilience of the institution will once more assist in containing the challenges to the institution in the 21st century.
The Invisible Hand of the Royal Family in the Political Dynamics of Swaziland
Authors: Sihlongonyane Mfaniseni Fana
Published: July 2003

Why does Swaziland remain authoritarian despite the democratic political changes that have occurred in the other parts of the African continent since the 1990s? Does it mean that Swaziland is immune to political change? The answers to these questions are diverse and wide-ranging from the international relations view to the radical perspectives and to the functionalist view. But the tendency of these views is to analyse Swazi politics according to historically constructed and particularised contexts and dynamics without fusing the wide-ranging factors that play various roles in the politics of the country. One of the major assumptions by these views is that the state (royal family) and the nation (subjects) are the same as was the case in the pre-colonial period and that the state has a sole privilege to cultural instrumentalism. These views therefore have a tendency to explain political change in terms of class structure and capital relations without taking the multifunctional dimensions of culture into consideration. This paper brings together the various views to explain political resistance in the country in terms of a cleavage between the state and the nation. It provides a historical overview of the political transformation in the country within a framework of cultural nationalism. The thrust of the paper is to look at how the royal family has survived between a primordial and constructivist perspective to political change from the colonial to the post-colonial period. It subjects both the incumbent and the opposition onto a critical analysis and points out a possible direction for political resolve.
A General Review of the Conceptual Dimensions of Quality of Leisure, Tourism, and Sports with a Particular Focus on Iran
Authors: Sheykhi Mohammad Taghi
Published: July 2003

The paper explores how quality of life is influenced by leisure, tourism, and sports. While these three concepts are counted as the cultural needs of the current industrial and especially urban life, they are not well-provided in many parts of the Third World. While working hours are shortened in the industrial world, followed by provision of leisure and tourism, leisure opportunities are less prevalent in the developing world including many parts of Asia. It should be kept in mind that changes in the quantitative aspects of such concepts lead to qualitative change in any society. This trinity, which also leads to modernization and development, acts as an economic multiplier as well. Today, while the industrial countries invest on employment, they simultaneously do the same on leisure time and sports. Under the overall conditions, the developing countries, including Iran, have yet a long way to go.
Linguistic Environment of Secondborn Children
Authors: Oshima-Takane Yuriko , Robbins Medina
Published: July 2003

The present study investigated whether the presence of an older sibling affects the language secondborn children hear. In particular, we investigated whether mothers' distribution of language across the three functional categories of metalingual, referential and social-regulative would differ from a mother-child dyadic to a mother-child-sibling triadic context, in support of Nelson's (1981) hypothesis. In addition, we investigated how older siblings' speech to both the child and the mother in the triadic context contributes to the linguistic environment of the secondborn children. Fourteen English-speaking secondborn children were videotaped at 21 months of age in two 25-minute free-play sessions, one with their mothers and the other with their mothers and older siblings. Mothers' and older siblings' utterances were analysed in terms of three function categories. The results provided evidence for Nelson's hypothesis that in the triadic context, mothers used more language centred around children's activities and social exchanges (social-regulative language), whereas in the dyadic context, they used more language-focused language (meta-lingual language). Furthermore, older siblings' utterances to the secondborn in the triadic context were overwhelmingly social-regulative, whereas their utterances to the mother were more metalingual and referential. These results suggest that linguistic environment of secondborn children is qualitatively different from that of firstborn children.
Learning about Different Ways of Expressing Number in the Development of Palestinian Arabic
Authors: Ravid Dorit , Hayek Lubna
Published: July 2003

The paper describes the acquisition of three number categories - sound feminine noun plurals, duals, collectives - in a dialect of Palestinian Arabic spoken in the north of Israel. The study population consisted of 58 children aged 3;6-4;6, 5;0-6;0, 6;0-7;0, and 7;0-8;0, all monolingual speakers of Palestinian Arabic as their mother tongue. Thirty noun stimuli denoting fruits and vegetables familiar to young children were presented in pictures to elicit plural, dual and collective forms. Analysis of the correct results showed two different acquisition patterns: clear development in production of sound feminine nouns and dual nouns, and no increase above the initial 50% in producing collective nouns. Dual contexts elicited constructions preceded by the numeral `two'. Collectives and sound feminine plurals tended to replace each other. The study highlights children's perception of noun reference through their learning of how to express number distinctions in a sparsely investigated language that challenges its speakers by marking number in multiple and often opaque ways.
Prosodic Characteristics of Early Multi-Word Utterances in Italian Children
Authors: D'Odorico Laura , Carubbi Stefania
Published: July 2003

The capacity to relate two or more words into single intonational contours is an important phenomenon in the transition to early multi-word utterances, but there are few systematic investigations of the related acoustic properties. This study analysed the prosodic characteristics of early multi-word utterances produced by a sample of Italian children with the aim of verifying which prosodic models are detectable in early word combinations. The study focuses on the occurrence of the final syllable lengthening phenomenon. The 32 participants were 13-14 months old at the start of the study. Vocabulary development was assessed monthly up to approximately 200 words. Results show that the capacity to link two or more words in a single intonational contour is not fully developed during the production of the first multi-word utterances, and that final syllable lengthening, even if developed independently, is partially influenced by the development of intonational models.
Bedtime Talk of Three-Year-Olds: Collaborative Repair of Miscommunication
Authors: Aviezer Ora
Published: July 2003

Recordings of spontaneous bedtime conversations in which adult involvement is minimal were conducted during naptime at kibbutz children's houses. Participants were nine Hebrew-speaking children aged 2;8-3;6, who constituted three conversation groups. The study was designed to observe conversational processes in spontaneous interactions of young peers and it focused on their strategies of clarification in the face of miscommunication. Results show that all children participated in clarification sequences, although children younger than age three initiated significantly fewer clarifications. Children used various types of clarification requests, and 70% of their repair responses were appropriate. These findings suggest that young children are able to handle miscommunications and to succeed in conversational management without adult assistance.
The Unfulfilled Project of the Model Mental Hospital in Spain: Fifty Years of the Santa Isabel Madhouse, Leganés (1851-1900)
Authors: Villasante Olga , Dening Dr Tom
Published: July 2003

The scant attention paid to the mentally ill by the Spanish Administration in the nineteenth century was reflected in the country's run-down and overcrowded mental hospitals. It was not until the reign of Isabel II (1843-1869) that Provincial Councils (Diputaciones) officially took responsibility for the insane. In 1851 the Santa Isabel Madhouse in Leganés (Madrid), was opened as a National Mental Hospital. Several projects attempted to classify it as `a model home for the disturbed'.

The aim of the paper is to offer new data on the first fifty years of the institution (1851-1900). Original manuscripts from the National Historical Archive (Madrid) and criticisms published in the press are discussed. Various plans to improve the old building - as well as requests for assistance from the institution to the Administration - were repeatedly unsuccessful, and the institution was insufficient to provide national cover. The appointment of the celebrated psychiatrist Luis Simarro (1851-1921) as department head brought no improvement. At the end of the century, the Leganés Mental Hospital was far from being a `modern and model' establishment, and it had become a charity and an asylum.
Libro de la Melancholía by Andrés Velázquez (1585). Part 1. The Intellectual Origins of the Book
Authors: Mas Antonio Contreras , Balle Amparo Lafuente , Beer Dr M. Dominic
Published: July 2003

Part 1 of this paper examines views on melancholy from the Hellenic era (especially Hippocrates), the Roman era (especially Galen), Arab physicians (Ishaq Ibn Imran, Rhazes and Avicenna) and the views of physicians from the Renaissance period. The medical orthodoxy followed Galenic theory as late as the sixteenth century, regarding melancholy as a disease of the body.
Controlling Legionnaire's Disease
Authors: Brundrett Geoffrey
Published: July 2003

Legionnaires' disease is a rare but life threatening form of pneumonia caused by inhalation of fine water droplets contaminated with Legionella bacteria. In the urban environment the disease is usually associated with poor building design, inappropriate construction and/or negligent maintenance of the water services within buildings. It is therefore effectively a man-made disease, which is normally preventable. Fortunately, most people exposed to the bacterium do not develop the disease: it is a disease of susceptibility. Predisposing factors are age above 50 years, males (a 3-fold excess over females), smoking and the existence of an underlying illness.

Britain was among the first countries to introduce legislation and technical guidance to minimise the risk of Legionellosis. This paper describes current good practice in assessing the risk. A recent review of compliance shows that employers should give more attention to the maintenance of their buildings. The starting point is to nominate a person at managerial level to accept responsibility for water hygiene within the company.
Legionella Pneumophila Airway Colonisation in Patients Admitted to Hospital
Authors: Jarešová M. , Petříčková K. , Korčáková L. , Böhmová R. , Puchmajerová J. , Zazula R. , Stříž I. , Totušek P. , Hložánek I.
Published: July 2003

Nosocomial infections are often caused by the opportunistic pathogen Legionella pneumophila which may cause a life-threatening disease in immuno-compromised individuals. Infection may occur either by inspiration of contaminated aerosol, or by aspiration of contaminated water. A large number of nosocomial infections, community infections, or travel-related infections have been reported. For nosocomial infections the most frequent route of transmission is aspiration, often from water taps and showerheads, while travel-related infection is more often aerosolborne. Person-to-person transmission has not been demonstrated. Diagnosis of Legionella can be confirmed in the laboratory by a variety of techniques including evidence of urinary antigen, direct immunofluorescence, PCR, evidence of an elevated specific antibody titre or best of all culture. Transplant patients are at particular risk during an outbreak and if infected may not survive. An outbreak at the Institute for Clinical and Experimental Medicine lead to remedial action to remove the organism from the hot water supply system and now superheating and disinfection is regularly carried out together with monitoring for Legionella. To examine a possible role for oropharyngeal colonisation in disease transmission to patients undergoing immunosuppressive therapy aspirates from the upper airways of patients have been examined. A number of patients monitored before surgery for kidney, liver, and pancreas transplantation have shown a Legionella DFA positive reaction. Over the study period 24/324 kidney, 16/95 liver and 6/36 pancreas transplant candidates have been tested positive.