bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of Ischemic Core Volume Using Computed Tomographic Perfusion
Authors: Sakai Yu , Delman Bradley N. , Fifi Johanna T. , Tuhrim Stanley , Wheelwright Danielle , Doshi Amish H. , Mocco J , Nael Kambiz 
Published: September 2018

Background and Purpose—
Estimation of infarction based on computed tomographic perfusion (CTP) has been challenging, mainly because of noise associated with CTP data. The Bayesian method is a robust probabilistic method that minimizes effects of oscillation, tracer delay, and noise during residue function estimation compared with other deconvolution methods. This study compares CTP-estimated ischemic core volume calculated by the Bayesian method and by the commonly used block-circulant singular value deconvolution technique.

Methods—
Patients were included if they had (1) anterior circulation ischemic stroke, (2) baseline CTP, (3) successful recanalization defined by thrombolysis in cerebral infarction ≥IIb, and (4) minimum infarction volume of >5 mL on follow-up magnetic resonance imaging (MRI). CTP data were processed with circulant singular value deconvolution and Bayesian methods. Two established CTP methods for estimation of ischemic core volume were applied: cerebral blood flow (CBF) method (relative CBF, <30% within the region of delay >2 seconds) and cerebral blood volume method (<2 mL per 100 g within the region of relative mean transit time >145%). Final infarct volume was determined on MRI (fluid-attenuated inversion recovery images). CTP and MRI-derived ischemic core volumes were compared by univariate and Bland-Altman analysis.

Results—

Among 35 patients included, the mean/median (mL) difference for CTP-estimated ischemic core volume against MRI was −4/−7 for Bayesian CBF (
P
=0.770), 20/12 for Bayesian cerebral blood volume (
P
=0.041), 21/10 for circulant singular value deconvolution CBF (
P
=0.006), and 35/18 for circulant singular value deconvolution cerebral blood volume (
P
<0.001). Among all methods, Bayesian CBF provided the narrowest limits of agreement (−28 to 19 mL) in comparison with MRI.

Conclusions—
Despite existing variabilities between CTP postprocessing methods, Bayesian postprocessing increases accuracy and limits variability in CTP estimation of ischemic core.
Alberta Stroke Program Early CT Score Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke
Authors: Demeestere Jelle , Scheldeman Lauranne , Cornelissen Sandra A. , Heye Sam , Wouters Anke , Dupont Patrick , Christensen Sören , Mlynash Michael , Albers Gregory W. , Lansberg Maarten , Lemmens Robin 
Published: September 2018

Background and Purpose—
We aimed to compare the ability of conventional Alberta Stroke Program Early CT Score (ASPECTS), automated ASPECTS, and ischemic core volume on computed tomographic perfusion to predict clinical outcome in ischemic stroke because of large vessel occlusion ≤18 hours after symptom onset.

Methods—
We selected patients with acute ischemic stroke from the CRISP study (Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke Project) with successful reperfusion (modified treatment in cerebral ischemia score 2b or 3). We used e-ASPECTS software to calculate automated ASPECTS and RAPID software to estimate ischemic core volumes. We studied associations between these imaging characteristics and good outcome (modified Rankin Scale score, 0–2) or poor outcome (modified Rankin Scale score, 4–6) in univariable and multivariable analysis, after adjustment for relevant clinical confounders.

Results—

We included 156 patients. Conventional and automated ASPECTS was not associated with good or poor outcome in univariable analysis (
P
=nonsignificant for all). Automated ASPECTS was associated with good outcome in multivariable analysis (
P
=0.02) but not with poor outcome. Ischemic core volume was associated with good (
P
<0.01) and poor outcome (
P
=0.04) in univariable and multivariable analysis (
P
=0.03 and
P
=0.02, respectively). Computed tomographic perfusion predicted good outcome with an area under the curve of 0.62 (95% CI, 0.53–0.71) and optimal cutoff core volume of 15 mL.

Conclusions—
Ischemic core volume assessed on computed tomographic perfusion is a predictor of clinical outcome among patients in whom endovascular reperfusion is achieved ≤18 hours after symptom onset. In this population, conventional or automated ASPECTS did not predict outcome.
Optimization of Prehospital Triage of Patients With Suspected Ischemic Stroke
Authors: Ali Ayman , Zachrison Kori S. , Eschenfeldt Patrick C. , Schwamm Lee H. , Hur Chin 
Published: September 2018

Background and Purpose—
Prehospital routing algorithms for patients with suspected stroke because of large vessel occlusions should account for likelihood of benefit from endovascular therapy (EVT), risk of alteplase delays, and transport times. We built a mathematical model to give a real-time, location-based optimal emergency medical service routing location based on local resources, transport times, and patient characteristics.

Methods—
Using location, onset time, age, sex, and prehospital stroke severity, we calculated odds of a favorable outcome for a patient with suspected large vessel occlusions under 2 scenarios: direct to EVT-capable hospital versus transport to the nearest alteplase-capable hospital with transfer to EVT-capable hospital if appropriate. We project lifetime outcomes incorporating disability, quality of life utility, and cost. Multiple parameter sets of center-specific times (eg, door to alteplase) were randomly selected within a clinically plausible range to account for the model sensitivity to these estimates; for each iteration, the optimal strategy was defined as the most cost-effective outcome (threshold, $100 000 per quality-adjusted life-years gained). After 1000 simulations, the most frequently occurring optimal strategy was the final recommendation, with its strength measured as the proportion of runs for which it was optimal.

Results—
Routing recommendations were highly sensitive to small changes in model input parameters. Under many scenarios, the recommendations for direct transfer to the EVT site increased with increasing stroke severity and geographic proximity but did not vary substantially with respect to sex, age, or onset time.

Conclusions—
We present a mathematical decision model that determines ideal prehospital routing recommendations for patients with suspected stroke because of large vessel occlusions, with consideration of patient characteristics and location at onset. This model may be further refined by incorporating real-time data on traffic patterns and actual EVT and alteplase timeliness performance. Further studies are needed to verify model predictions.
Elevated Neutrophil and Presence of Intracranial Artery Stenosis Increase the Risk of Recurrent Stroke
Authors: Zhu Bihong , Liu Huihui , Pan Yuesong , Jing Jing , Li Hao , Zhao Xingquan , Liu Liping , Wang David , Johnston S. Claiborne , Wang Zhimin , Wang Yilong , Wang Yongjun ,   on behalf of the CHANCE Investigators
Published: September 2018

Background and Purpose—
The association of neutrophil and intracranial artery stenosis (ICAS) with the prognosis of stroke is uncertain. This study evaluated the relationship between neutrophil levels with and without ICAS and the prognosis of patients with minor stroke or transient ischemic attack.

Methods—
Data from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) was reviewed. Patients were divided into 4 groups according to the dichotomy of neutrophil counts and status of ICAS. The primary outcome was a new stroke (ischemic or hemorrhagic), and secondary outcomes included a new composite vascular event (stroke, myocardial infarction, or cardiovascular death) and ischemic stroke. Safety outcome was any hemorrhage at 90 days. The association between neutrophil counts with and without ICAS and risk of any outcome was analyzed by Cox regression models.

Results—

Of 1034 patients included in this subgroup analysis, 91 had recurrent strokes. Compared with the lower neutrophil levels without ICAS, higher neutrophil levels with ICAS significantly increased the risk of stroke recurrence (adjusted hazard ratio, 2.26; 95% CI, 1.19–4.31;
P
=0.01) and composite outcome (adjusted hazard ratio, 1.98; 95% CI, 1.06–3.67;
P
=0.03). However, there was no safety issue.

Conclusions—
Concomitant presence of higher neutrophil levels and ICAS was associated with the increased risk of stroke recurrence, and combined adverse outcome events in patients already had minor ischemic stroke or high-risk transient ischemic attack.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00979589.
Safety and Outcome of Endovascular Treatment in Prestroke-Dependent Patients
Authors: Goldhoorn Robert-Jan B. , Verhagen Merel , Dippel Diederik W.J. , van der Lugt Aad , Lingsma Hester F. , Roos Yvo B.W.E.M. , Majoie Charles B.L.M. , Vos Jan Albert , Boiten Jelis , van Zwam Wim H. , van Oostenbrugge Robert J. , van den Wijngaard Ido ,   on behalf of the MR CLEAN Registry Investigators
Published: September 2018

Background and Purpose—
Prestroke dependence is an exclusion criterion in most trials of endovascular treatment (EVT) for acute ischemic stroke. Little is known about outcomes after EVT in these patients. We compared outcome and safety of EVT between prestroke-dependent and prestroke-independent patients.

Methods—
We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke)—a prospective, multicenter, observational study for stroke intervention centers in the Netherlands. Prestroke dependence was defined as modified Rankin Scale score of 3 to 5 before onset of current stroke. Primary outcome was favorable outcome at 90 days, defined as modified Rankin Scale of 0 to 2 or not worsening of the modified Rankin Scale score. Secondary outcomes included National Institutes of Health Stroke Scale score post-intervention, reperfusion grade, and safety outcomes. Logistic regression analyses (adjusted for age, baseline National Institutes of Health Stroke Scale score, collaterals, time to EVT, and intravenous thrombolysis before EVT) were used to assess the association between prestroke dependence and outcomes.

Results—

One thousand four hundred forty-one patients were included in the present study, of whom 157 (11%) were prestroke dependent. Favorable outcome was seen in 27% prestroke-dependent patients, compared with 42% prestroke-independent patients (
P
<0.05). After adjustment, prestroke dependence was not associated with less-favorable outcome (OR
adjusted
, 0.90; 95% CI, 0.58–1.39). The occurrence of symptomatic intracranial hemorrhage and ischemic stroke progression was similar in both groups.

Conclusions—
A substantial proportion of prestroke-dependent patients will reach prestroke modified Rankin Scale scores after EVT, and complication rates are comparable with prestroke-independent patients. Therefore, prestroke-dependent patients should not be routinely excluded from EVT.
Microstructural Damage in Normal-Appearing Brain Parenchyma and Neurocognitive Dysfunction in Adult Moyamoya Disease
Authors: Hara Shoko , Hori Masaaki , Murata Syo , Ueda Ryo , Tanaka Yoji , Inaji Motoki , Maehara Taketoshi , Aoki Shigeki , Nariai Tadashi 
Published: September 2018

Background and Purpose
―Microstructural damage in the brain induced by chronic ischemia is suggested to play a pivotal role in the neurocognitive dysfunction of adults with Moyamoya disease (MMD). We investigated specific changes in the brain microstructure and their correlations with neurocognitive dysfunction in patients with MMD using a multishell diffusion magnetic resonance imaging technique called neurite orientation dispersion and density imaging.

Methods—
We evaluated 26 patients with MMD (16–63 years old, 20 females) and 20 age- and sex-matched normal volunteers using neurite orientation dispersion and density imaging and neuropsychological batteries. Neurite orientation dispersion and density imaging calculates 2 parameters: the intracellular volume fraction (Vic), which reflects the axon density in the white matter and dendrite density in the cortex, and the orientation dispersion index (OD), which reflects the network complexity. The microstructural damage and its correlation with neurocognitive performance were evaluated by performing a whole-brain analysis using SPM12 and correlation analysis with regional values.

Results—

Patients with MMD had significantly lower Vic in the white matter and a lower OD mainly in the cortex than those of the controls (
P
<0.001, family-wise error corrected). Of all neuropsychological scores, Processing Speed Index (PS) exhibited the strongest correlation with Vic in the white matter (
P
<0.001, family-wise error corrected). The Vic and OD values for regions with group differences, including both temporoparietal and frontal areas, correlated with neurocognitive performance (absolute r=0.37–0.64;
P
<0.01).

Conclusions—
Chronic ischemia in MMD may decrease the axon density in the white matter and dendrite density in the cortex (Vic) and simplify network complexity (OD), leading to neurocognitive dysfunction. Processing Speed Index may be the most sensitive index used to evaluate the ischemic burden, and the posterior part of the brain may play an important role in neurocognitive function.

Clinical Trial Registration—

URL:
http://www.umin.ac.jp/ctr/
. Unique identifier: UMIN000023082.
Incidence of Atrial Fibrillation in Patients With Recent Ischemic Stroke Versus Matched Controls
Authors: Witsch Jens , Merkler Alexander E. , Chen Monica Lin , Navi Babak B. , Sheth Kevin N. , Freedman Ben , Schwamm Lee H. , Kamel Hooman 
Published: September 2018

Background and Purpose—
It is unclear whether atrial fibrillation/flutter (AF) newly diagnosed after ischemic stroke represents a preexisting risk factor that led to stroke, an arrhythmia triggered by poststroke autonomic dysfunction, or an incidental finding.

Methods—

We compared AF incidence after hospitalizations for ischemic stroke, hemorrhagic stroke, and nonstroke conditions using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We used validated
International Classification of Diseases, Ninth Revision, Clinical Modification
(
ICD-9-CM
) codes to identify AF-free patients hospitalized with ischemic or hemorrhagic stroke and matched them in a 1:1 ratio by age, sex, race, calendar year, vascular risk factors, and Charlson comorbidities. We then matched the combined stroke cohort in a 1:1 ratio to patients hospitalized for nonstroke diagnoses. We used survival statistics and Cox regression to compare postdischarge AF incidence among groups.

Results—

We matched 2580 patients with ischemic stroke, 2580 with hemorrhagic stroke, and 5160 patients with other conditions. The annual postdischarge AF incidence was 3.4% (95% CI, 3.1%–3.7%) after ischemic stroke, 2.2% (95% CI, 1.9%–2.4%) after hemorrhagic stroke, and 2.9% (95% CI, 2.6%–3.1%) after nonstroke hospitalization. Ischemic stroke was associated with a somewhat higher risk of AF than hemorrhagic stroke (hazard ratio, 1.5; 95% CI, 1.3–1.8) or nonstroke conditions (hazard ratio, 1.2; 95% CI, 1.1–1.3). The latter association attenuated in sensitivity analyses limiting the outcome to AF diagnoses made by cardiologists (hazard ratio, 1.1; 95% CI, 0.8–1.5) or limiting the outcome to a minimum of 2 AF claims on separate dates (hazard ratio, 1.2; 95% CI, 1.0–1.5;
P
=0.09).

Conclusions—
New diagnoses of AF were more common after hospitalization for ischemic stroke than after hospitalization for hemorrhagic stroke or nonstroke conditions, but all hospitalized patients had a substantial incidence of new AF diagnoses after discharge and differences were attenuated when using more stringent definitions.
Political Office and the Rule of Law in Plato’s Statesman
Authors: Sørensen Anders Dahl 
Published: September 2018

Abstract
The article discusses the relation between political office (archē) and the rule of law in Plato’s dialogue Statesman. Taking its starting-point from an observation about the Statesman’s peculiar approach to constitutional analysis, the article argues that what Plato is concerned to show is how the reconceptualisation of the role of law in government proposed in that dialogue has important implications for what we take the role of the institution of office-holding to be. While Greek political tradition held the main aim of archē to be the formal circumscription and control of official power within a constitutional order, Plato insists that it should primarily be understood as ensuring that the exercise of political power approximates, by means of law, the ideal rule by a political expert. The article ends by pointing out how this reading complements another recent discussion of office-holding in the Statesman.
Resemblance, Resonance and Reconstitution: Some Remarks on Śaṃkara and Creative Skepsis
Authors: Ovens Martin 
Published: September 2018

Abstract
This essay explores the possibility of dialogue between creative skepsis and Śaṃkara’s Advaita Vedānta based on a phenomenology of the structure and dynamics of both traditions. Externally, the essay shows how critical reflection on Śaṃkara/West comparative philosophy may culminate in standpoints of creative skepsis. Internally, the essay indicates how both traditions “resonate” as living “via negativas” that involve disciplines of enquiry within the practical context of a way of life.
Cost-effectiveness of the HiBalance training program for elderly with Parkinson’s disease: analysis of data from a randomized controlled trial
Authors: Joseph Conran , Brodin Nina , Leavy Breiffni , Hagströmer Maria , Löfgren Niklas , Franzén Erika 
Published: September 2018

Objective: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. Design: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. Subjects: A total of 100 participants with mild–moderate PD were randomized to either the intervention ( n = 51) or the control group ( n = 49). Intervention: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. Main outcomes: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. Results: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. Conclusion: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.
Exploring the Channels and Impact of Debt on Economic Growth
Authors: Munir Kashif , Mehmood Nisma Riffat 
Published: September 2018

The objective of this study is to analyse the effect of debt on economic growth as well as the channels, that is, investment, total factor productivity (TFP), interest rate and saving channel through which debt affects economic growth in South Asian countries. The study uses growth model based on conditional convergence and augments to include debt. Panel data of four South Asian countries from 1990 to 2013 at annual frequency are utilized and fixed effect model is used for estimation. The results of the study showed that inverted U-shaped relationship exists between debt and economic growth in South Asian countries. However, the most important and significant channel through which debt affects economic growth is private and public investment as well as TFP. Reducing debt accumulation alone will not rectify the problem unless the supplementary macroeconomic policies are made sound; therefore, there is a dire need to improve macroeconomic policies, good governance and elimination of structural distortions. JEL: C23, H6, O47
Services Outsourcing and Productivity Growth
Authors: Mukherjee Sonia 
Published: September 2018

The article studies the impact of outsourcing services on the productivity growth of the Indian manufacturing firms. By the term services we mean different expenses on services incurred by the manufacturing firms, such as, advertising, marketing, research and development, consultancy, auditing, business services, knowledge-based services, technical, legal and other professional services (including information communication and technology services). With further expansion in newer services, a higher demand has come from the Indian manufacturing sector. With intensive usage of services in the manufacturing production process, the performance and the manufacturing can focus on the core competencies with outsourced and cheaper services from expert service provider. For this purpose, the firm-level data have been collected from the annual financial statements of the Centre for Monitoring of the Indian Economy’s Prowess database. The econometric results conclude that services have played a positive role in improving the productivity growth of the aggregate Indian manufacturing firms and at the disaggregated level, especially for industrial groups such as food, beverage and tobacco; textiles, gems and jewellery; transport; machinery; metal, rubber and plastic; leather and footwear; and chemicals, services have played a favourable role in boosting the productivity growth. JEL: D24, L80, L60