bluuebunny/crossref_metadata_2025_split huggingface dataset:
Education, sex and risk of stroke: a prospective cohort study in New South Wales, Australia
Authors: Jackson Caroline A , Sudlow Cathie L M , Mishra Gita D 
Published: September 2018

ObjectiveTo determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.DesignProspective cohort study.SettingPopulation based, New South Wales, Australia.Participants253 657 stroke-free participants from the New South Wales 45 and Up Study.Outcome measuresFirst-ever stroke events, identified through linkage to hospital and mortality records.ResultsDuring mean follow-up of 4.7 years, 2031 and 1528 strokes occurred among men and women, respectively. Age-standardised stroke rate was inversely associated with education level, with the absolute risk difference between the lowest and highest education group greater among women than men. In relative terms, stroke risk was slightly more pronounced in women than men when comparing low versus high education (age-adjusted HRs: 1.41, 95% CI 1.16 to 1.71 and 1.25, 95% CI 1.07 to 1.46, respectively), but there was no clear evidence of statistical interaction. This association persisted into older age, but attenuated. Much of the increased stroke risk was explained by modifiable lifestyle factors, in both men and women.ConclusionLow education is associated with increased stroke risk in men and women, and may be marginally steeper in women than men. This disadvantage attenuates but persists into older age, particularly for women. Modifiable risk factors account for much of the excess risk from low education level. Public health policy and governmental decision-making should reflect the importance of education, for both men and women, for positive health throughout the life course.
Protocol for the insight study: a randomised controlled trial of single-dose tocilizumab in patients with depression and low-grade inflammation
Authors: Khandaker Golam M , Oltean Bianca P , Kaser Muzaffer , Dibben Claire R M , Ramana Rajini , Jadon Deepak R , Dantzer Robert , Coles Alasdair J , Lewis Glyn , Jones Peter B 
Published: September 2018

IntroductionObservational studies indicate a potentially causal role for interleukin 6 (IL-6), a proinflammatory cytokine, in pathogenesis of depression, but interventional studies based on patients with depression have not been conducted. Tocilizumab, anti-inflammatory drug, is a humanised monoclonal antibody that inhibits IL-6 signalling and is licensed in the UK for treatment of rheumatoid arthritis. The main objectives of this study are to test whether IL-6 contributes to the pathogenesis of depression and to examine potential mechanisms by which IL-6 affects mood and cognition. A secondary objective is to compare depressed participants with and without evidence of low-grade systemic inflammation.Methods and analysisThis is a proof-of-concept, randomised, parallel-group, double-blind, placebo-controlled clinical trial. Approximately 50 participants with International Classification of Diseases 10th revision (ICD-10) diagnosis of depression who have evidence of low-grade inflammation, defined as serum high-sensitivity C reactive protein (hs-CRP) level ≥3 mg/L, will receive either a single intravenous infusion of tocilizumab or normal saline. Blood samples, behavioural and cognitive measures will be collected at baseline and after infusion around day 7, 14 and 28. The primary outcome is somatic symptoms score around day 14 postinfusion. In addition, approximately, 50 depressed participants without low-grade inflammation (serum hs-CRP level <3 mg/L) will complete the same baseline assessments as the randomised cohort.Ethics and disseminationThe study has been approved by the South Central—Oxford B Research Ethics Committee (REC) (Reference: 18/SC/0118). Study findings will be published in peer-review journals. Findings will be also disseminated by conference/departmental presentations and by social and traditional media.Trial registration numberISRCTN16942542; Pre-results.
Health economics and quality of life in a feasibility RCT of paediatric acute appendicitis: a protocol study
Authors: Chorozoglou Maria , Reading Isabel , Eaton Simon , Hutchings Natalie , Hall Nigel J 
Published: September 2018

BackgroundAcute appendicitis is one of the most common acute surgical emergencies in children and accounts for an annual cost of approximately £50 million to the National Health Service. Investigating alternative treatment options offers the best prospect of enhancing the quality of care for patients and potential opportunities for cost savings through better allocative efficiency. A feasibility randomised controlled trial (RCT) comparing a non-operative treatment pathway with appendicectomy for children with acute uncomplicated appendicitis is underway (CONTRACT feasibility RCT).AimsThe prime objective of this economic substudy conducted alongside the CONTRACT feasibility RCT is to better understand and assess: (1) cost data collection tools and cost drivers by identifying patients’ pathways and (2) patient quality of life by assessing alternative paediatric health-related quality of life (HRQoL) instruments. Outcomes from this study will inform a future efficacy RCT assessing the effectiveness and cost-effectiveness of non-operative treatment pathway for the treatment of acute uncomplicated appendicitis in children.MethodsThe economic substudy will use individual-level data and will be conducted from the health system perspective over the study’s 6-month follow-up period. Microcosting will include health resource and service use, while potential benefits acquired will be measured using the HRQoL measures, Child Health Utility 9D (CHU-9D) and Euroqol-5 dimensions and 5 levels (EQ-5D-5L). We will assess the appropriateness of using the cost per quality-adjusted life year framework in the future RCT, as well as testing and identifying the most suitable HRQoL instrument.ConclusionsThe outcomes of the investigational economic substudy will be used to inform the design of our future definitive RCT. However, the result from this economic study will also provide a detailed description and account of the issues inherent in paediatric Economic Evaluations Alongside Clinical Trials with an emphasis on costing methods of interventions taking place in secondary care settings.Trial registration numberISRCTN1583043.
Cross-sectional survey of the undergraduate rheumatology curriculum in European medical schools: a EULAR School of Rheumatology initiative
Authors: Abhishek Abhishek , Iagnocco Annamaria , Bijlsma J W J , Doherty Michael , Lioté Frédéric 
Published: September 2018

ObjectivesTo survey the undergraduate rheumatic and musculoskeletal diseases (RMDs) curriculum content in a sample of medical schools across Europe.MethodsThe undergraduate musculoskeletal diseases and disability curriculum of University of Nottingham, UK, was used as a template to develop a questionnaire on curriculum content. The questionnaire elicited binary (yes/no) responses and included the option to provide additional information as free text. The survey was mailed to members of the European League Against Rheumatism (EULAR) School of Rheumatology (Undergraduate Classroom) and to EULAR Standing Committee on Education and Training members in January 2017, with a reminder in February 2017.ResultsResponses were received from 21 schools belonging to 11 countries. Assessment of gait, hyperalgesic tender site response and hypermobility were not included in many curricula. Similarly, interpretation of investigations undertaken on synovial fluid was taught in only 16 schools. While disease-modifying anti-rheumatic drugs and biological agents, and urate-lowering treatment were included in the curricula of 20 and 21 institutions, respectively, only curricula from 18 schools included core non-pharmacological interventions. Osteoarthritis, gout, rheumatoid arthritis, spondyloarthropathy, polymyalgia rheumatica and lupus were included in the curriculum of all institutions. However, common RMDs such as calcium pyrophosphate deposition, fibromyalgia, giant cell arteritis and bone and joint infection were included in 19 curricula.ConclusionThis survey highlights areas of similarities and differences in undergraduate curricula across Europe. It is hoped that the results of this survey will catalyse the development and agreement of a minimum core European Curriculum for undergraduate education in RMDs.
Reversal of Vitamin K Antagonist Therapy Before Thrombolysis for Acute Ischemic Stroke
Authors: Chausson Nicolas , Soumah Djibril , Aghasaryan Manvel , Altarcha Tony , Alecu Cosmin , Smadja Didier 
Published: September 2018

Background and Purpose—
Acute ischemic strokes under vitamin K antagonist (VKA) treatment are not uncommon, but intravenous thrombolysis (IVT) is not recommended for international normalized ratio (INR) >1.7 because of the excess bleeding risk. However, VKA-induced anticoagulation can be easily reversed by IV infusions of 4-factor prothrombin complex concentrate bolus and vitamin K. Our pilot study aimed to determine whether IVT immediately after anticoagulation reversal could be feasible and safe in acute ischemic stroke patients under VKA with INR >1.7.

Methods—
Consecutive acute ischemic stroke patients, otherwise eligible for IVT except for VKA intake and INR >1.7, were given IVT after infusing 4-factor prothrombin complex concentrate and vitamin K. Safety and efficacy were assessed clinically and by cerebral imaging at 24 hours.

Results—
Twenty-six patients (age, 77.8±12.8 years; atrial fibrillation, 84.6%; initial National Institutes of Health Stroke Scale, 11.6±5.6) were prospectively included. INR values were 2.3±0.6 initially and 1.3±0.2, 5 minutes postreversal. No symptomatic intracranial hemorrhage or thrombotic events occurred during the first 3 days. One patient developed major systemic hemorrhoidal bleeding that required blood transfusion; 61.5% of the patients were independent (modified Rankin Scale score of ≤2) at 3 months.

Conclusions—
A reversal strategy of 4-factor prothrombin complex concentrate bolus and vitamin K before IVT could be feasible and safe in acute ischemic stroke patients under VKA with INR >1.7. Well-designed, randomized controlled trials are warranted to confirm these preliminary findings.
Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection
Authors: McNally J. Scott , Hinckley Peter J. , Sakata Akihiko , Eisenmenger Laura B. , Kim Seong-Eun , De Havenon Adam H. , Quigley Edward P. , Iacob Eli , Treiman Gerald S. , Parker Dennis L. 
Published: September 2018

Background and Purpose—
Cervical artery dissection is a major cause of ischemic stroke in the young and presents with various imaging findings, including stenosis and intramural hematoma (IMH). Our goal was to determine the relative contribution of lumen findings and IMH to acute ischemic stroke and whether a heavily T1-weighted sequence could more reliably detect IMH.

Methods—

Institutional review board approval was obtained for this retrospective study of 254 patients undergoing magnetic resonance imaging/magnetic resonance angiography for suspected dissection. Imaging included standard turbo spin–echo (TSE) T1-fat saturation and heavily T1-weighted flow-suppressed magnetization-prepared rapid acquisition gradient–recalled echo sequences. Subjects with stents (1) or atherosclerotic disease (26) were excluded, leaving 227 subjects. Kappa analysis was used to determine IMH interrater reliability on magnetization-prepared rapid acquisition gradient–recalled echo and T1-fat saturation in 4 vessels per subject. Lumen findings, cardiovascular risk factors, medications, and nondissection stroke sources were recorded. Mixed-effects multivariate Poisson regression was used to determine the prevalence ratio of each factor with acute ischemic stroke, accounting for 4 vessels per patient with backward elimination to a threshold
P
value of 0.10.

Results—

Patients were 41.9% men, mean age of 47.3±16.6 years, with 114 dissections and 107 strokes. IMH interrater reliability was significantly higher for magnetization-prepared rapid acquisition gradient–recalled echo (κ=0.83; 95% CI, 0.78–0.86) versus T1-fat saturation (0.58; 95% CI, 0.57–0.68). The final acute stroke prediction model included magnetization-prepared rapid acquisition gradient–recalled echo-detected IMH (prevalence ratio, 2.0; 95% CI, 1.1–3.9;
P
=0.034), stenosis, pseudoaneurysm, male sex, current smoking, and nondissection stroke sources. The final model had high discrimination for acute stroke (area under the curve, 0.902; 95% CI, 0.872–0.932), compared with models without stenosis (0.861; 95% CI, 0.821–0.902), and without stenosis and IMH (0.831; 95% CI, 0.783–0.879). All 3 models were significantly different at
P
<0.05.

Conclusions—
Along with stenosis, IMH detection significantly contributed to acute ischemic stroke pathogenesis in patients with suspected cervical artery dissection. In addition, IMH detection can be made more reliable with heavily T1-weighted sequences.
Operator Versus Core Lab Adjudication of Reperfusion After Endovascular Treatment of Acute Ischemic Stroke
Authors: Zhang Guang , Treurniet Kilian M. , Jansen Ivo G.H. , Emmer Bart J. , van den Berg Rene , Marquering Henk A. , Uyttenboogaart Maarten , Jenniskens Sjoerd F.M. , Roos Yvo B.W.E.M. , van Doormaal Pieter Jan , van Es Adriaan C.G.M. , van der Lugt Aad , Vos Jan-Albert , Lycklama à Nijeholt Geert J. , van Zwam Wim H. , Shi Huaizhang , Yoo Albert J. , Dippel Diederik W.J. , Majoie Charles B.L.M. ,   for the MR CLEAN Registry Investigators
Published: September 2018

Background and Purpose—
The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.

Methods—
All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.

Results—

In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%–59%). In 33% (95% CI, 31%–36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%–14%];
P
<0.001). In 252 (33%) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0–2; C statistic of both models: 0.83) equally well.

Conclusions—
Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.
Long-Term Consequences of Worsened Poststroke Status in Patients With Premorbid Disability
Authors: Ganesh Aravind , Luengo-Fernandez Ramon , Pendlebury Sarah T. , Rothwell Peter M. ,   on behalf of the Oxford Vascular Study
Published: September 2018

Background and Purpose—
Patients with premorbid disability, generally defined as modified Rankin Scale (mRS) score ≥2, are often excluded from trials of acute stroke therapies. However, increased disability in such patients will adversely affect long-term outcomes if treatments are withheld in routine practice. We assessed the extent to which increased disability poststroke influences 5-year mortality, institutionalization, and costs in premorbidly disabled patients.

Methods—
In a population-based, prospective cohort of patients with ischemic stroke (OXVASC [Oxford Vascular Study], 2002–2014), we tracked mortality, institutionalization, and healthcare/social-care costs during follow-up. We compared 5-year mortality and poststroke institutionalization (Cox regressions) and 5-year healthcare/social-care costs (generalized linear model) in 3-month survivors with premorbid mRS of 2 to 4 (excluding extreme disability, mRS=5), based on the degree of change in mRS(ΔmRS) from prestroke to 3 months poststroke, adjusting analyses for age/sex/initial National Institutes of Health Stroke Scale.

Results—

Among 1607 patients, 530 (33.0%) had premorbid mRS of 2 to 4. Only 2 premorbidly disabled patients received thrombolysis, but 421 (79.4%) were alive at 3 months. ΔmRS was independently associated with 5-year mortality/institutionalization (adjusted hazard ratio for ΔmRS=1 versus 0: 1.59; 95% CI, 1.20–2.11; ΔmRS=2: 2.39; 95% CI, 1.62–3.53; ΔmRS=3: 4.12; 95% CI, 1.98–8.60;
P
<0.001) and costs (margin for ΔmRS ≥2 versus 0: $30 011, 95% CI, $4222–55 801;
P
=0.023). Results were similar on examining patients with premorbid mRS of 2, 3, and 4 separately (eg, 5-year mortality/institutionalization adjusted hazard ratio for premorbid mRS=3 with ΔmRS=1 versus 0: 1.60; 95% CI, 1.06–2.42;
P
=0.027; ΔmRS=2: 3.20; 95% CI, 1.85–5.54;
P
<0.001).

Conclusions—
Patients with stroke with premorbid disability have higher mortality, institutionalization, and costs if they accumulate additional disability because of the stroke. These findings highlight the long-term outcomes expected if acute interventions are routinely withheld in patients with mild-moderate premorbid disability and suggest that trials/registries should include such patients.
Three-Dimensional Volumetric Evaluation of the Maxillary Sinuses in Chronic Rhinosinusitis Surgery
Authors: Valtonen Olli , Bizaki Argyro , Kivekäs Ilkka , Rautiainen Markus 
Published: September 2018

Introduction: The objective of this study was to ascertain whether the 3-dimensional volumetric measurement method could be used for the evaluation of operative treatment results in patients with chronic rhinosinusitis. Methods: A total of 61 adult patients with chronic rhinosinusitis were analyzed. Cone-beam computed tomographic images of the paranasal sinuses were examined preoperatively and at 12 months postoperatively. The results were compared using the Sino-Nasal Outcome Test (SNOT-22) and the Lund-Mackay (LM) and Zinreich modified staging systems. Results: The mean change in pneumatized volumes in the maxillary sinuses after operative treatment per patient was 2.0 ± 7.5 cm3 ( P = .146). The median for volumetric change was 0.97 cm3 (range, –11.6 to 33.6 cm3). Both the LM and Zinreich modified LM staging systems showed no change in 32 of 61 patients (53%). The alterations in patients’ maxillary sinuses measured using the volumetric measurement method correlated well with changes in Zinreich’s modified LM staging (−0.77, P < .01). Conclusions: The 3D volumetric method is more sensitive in detecting small alterations in pneumatized volumes of the maxillary sinuses than Zinreich’s modified LM staging and LM staging. The method correlates better with Zinreich’s modified LM staging than with LM staging.
Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report
Authors: Zhou Jiang , Xiao Rui , Yang Jing-rui , Wang Lu , Wang Jia-xing , Zhang Qian , Ren Jian-jun 
Published: September 2018

Background Mirizzi syndrome is a rare complication of chronic cholecystitis, usually caused by gallstones impacted in the cystic duct or the neck of the gallbladder. Mirizzi syndrome results in compression of the hepatic duct or fistula formation between the gallbladder and common bile duct (or hepatic duct, right hepatic duct, or even mutative right posterior hepatic duct). Clinical features include abdominal pain, fever, and obstructive jaundice. Severe inflammation and adhesion at Calot’s triangle are potentially very dangerous for patients with Mirizzi syndrome undergoing cholecystectomy. Case presentation: We report the case of a 68-year-old Asian woman who presented with abdominal pain and jaundice. She had a medical history of gallstones, but no fever. Magnetic resonance cholangiopancreatography revealed cholecystitis, cholelithiasis, common hepatic duct stones, and ascites. Findings at surgery included a porcelainized, atrophic gallbladder that was full of gallstones, fistula formation between the gallbladder and common hepatic duct, and left hepatic atrophy. The prominent feature was the left hepatic atrophy, but stones were not visible pre-operatively in the left liver by radiologic examination. Conclusions This patient exhibited what can be considered a special type II of Mirizzi syndrome with a fistula of the common hepatic duct as well as left hepatic atrophy.
Measuring the Profit Rate in an Inflationary Context: The Case of Brazil, 1955–2008
Authors: Marquetti Adalmir Antonio , Morrone Henrique , Miebach Alessandro , Ourique Luiz Eduardo 
Published: September 2018

A debate in Marxist literature concerns the methodology for measuring the profit rate. This paper investigates this question computing the rate of profit at historical cost, current cost, constant prices, and constant GDP price for Brazil in the 1955–2008 period. Like many developing countries, Brazil experienced medium to high inflation during this period. Inflation determined the trend and cyclical movements of the profit rate at historical cost. It increased in years of rising, and declined in years of falling, inflation. The profit rate at historical cost was at odds with Brazilian economic history. The profit rate at current costs remained unaffected by the inflation rate, and its movements correspond to the historical phases of the Brazilian economy. The same is true for the profit rate at constant prices and at constant GDP price. However, the profit rate at constant prices does not account for changes in relative prices, while the profit rate at constant GDP price is computed using a weighted average of the current and past relative prices. JEL Classification: E01, B51
Foucault, Simon Springer, and Postneoliberalism
Authors: Izsó Jaycob 
Published: September 2018

Scholarship in Foucauldian governmentality has reemerged as a critical area of contemporary political discourse and has had a pronounced effect on neoliberal and postneoliberal research in the wake of the 2008 financial crisis. Perhaps the most versatile postneoliberal critic is Simon Springer, who has offered dynamic accounts of neoliberalism and its decline via a Foucauldian method. While Springer’s research is novel, I believe it is not a rigorous Foucauldian account of neoliberalism and its future. JEL Classification: B00, F01, N00