bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke
Authors: Daou Badih , Kent Anthony P. , Montano Maria , Chalouhi Nohra , Starke Robert M. , Tjoumakaris Stavropoula , Rosenwasser Robert H. , Jabbour Pascal 
Published: November 2015

OBJECT
Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that puts them at risk of death unless intervention is performed. The purpose of this study was to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke.

METHODS
The authors conducted a retrospective electronic medical record review of 1624 patients from 2006 to 2014. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both. Ninety-five individuals were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS). Clinical outcome was assessed at 90 days and at the latest follow-up (mean duration 16.5 months).

RESULTS
The mean mRS score at 90 days and at the latest follow-up post-DH was 4. Good functional outcome was observed in 40% of patients at 90 days and in 48% of patient at the latest follow-up. The mortality rate at 90 days was 18% and at the last follow-up 20%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS scores of 4–6) in patients with a history of stroke (OR 6.54 [95% CI1.39–30.66]; p = 0.017), peak midline shift (MLS) > 10 mm (OR 3.35 [95% CI 1.33–8.47]; p = 0.011), or a history of myocardial infarction (OR 8.95 [95% CI1.10–72.76]; p = 0.04). Multivariate analysis demonstrated elevated odds of poor functional outcome associated with a history of stroke (OR 9.14 [95% CI 1.78–47.05]; p = 0.008), MLS > 10 mm (OR 5.15 [95% CI 1.58–16.79; p = 0.007), a history of diabetes (OR 5.63 [95% CI 1.52–20.88]; p = 0.01), delayed time from onset of stroke to DH (OR 1.32 [95% CI 1.02–1.72]; p = 0.037), and evidence of pupillary dilation prior to DH (OR 4.19 [95% CI 1.06–16.51]; p = 0.04). Patients with infarction involving the dominant hemisphere had higher odds of unfavorable functional outcome at 90 days (OR 4.73 [95% CI 1.36–16.44]; p = 0.014), but at the latest follow-up, cerebral dominance was not significantly related to outcome (OR 1.63 [95% CI 0.61–4.34]; p = 0.328).

CONCLUSIONS
History of stroke, diabetes, myocardial infarction, peak MLS > 10 mm, increasing duration from onset of stroke to DH, and presence of pupillary dilation prior to intervention are associated with a worse functional outcome.
Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography
Authors: Funaki Takeshi , Takahashi Jun C. , Yoshida Kazumichi , Takagi Yasushi , Fushimi Yasutaka , Kikuchi Takayuki , Mineharu Yohei , Okada Tomohisa , Morimoto Takaaki , Miyamoto Susumu 
Published: November 2015

OBJECT
The authors’ aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage.

METHODS
This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses.

RESULTS
Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κw = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p < 0.01 for trend). Univariate analysis revealed that age (p = 0.02) and periventricular anastomosis score (p < 0.01) were factors tentatively associated with hemorrhagic presentation. The score remained statistically significant after adjustment for age (OR 3.38 [95% CI 1.84–7.00]).

CONCLUSIONS
The results suggest that periventricular anastomosis detected with MR angiography can be scored with good intra- and interrater reliability and is associated with hemorrhagic presentation at onset in moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.
Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center
Authors: Lockwood Megan M. , Smith Gabriel A. , Tanenbaum Joseph , Lubelski Daniel , Seicean Andreea , Pace Jonathan , Benzel Edward C. , Mroz Thomas E. , Steinmetz Michael P. 
Published: November 2015

OBJECT
Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures.

METHODS
A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio’s Level I trauma institution from 2002 to 2012 was performed.

RESULTS
There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio’s Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke.

CONCLUSIONS
Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified.
Correlation of quality of life and functional outcome measures for cervical spondylotic myelopathy
Authors: Lubelski Daniel , Alvin Matthew D. , Nesterenko Sergiy , Sundar Swetha J. , Thompson Nicolas R. , Benzel Edward C. , Mroz Thomas E. 
Published: November 2015

OBJECT
Studies comparing surgical treatments for cervical spondylotic myelopathy (CSM) are heterogeneous, using a variety of different quality of life (QOL) outcomes and myelopathy-specific measures. This study sought to evaluate the relationship of these measures to each other, and to better understand their use in evaluating patients with CSM.

METHODS
A retrospective study was performed in all patients with CSM who underwent either ventral or dorsal cervical spine surgery at a single tertiary-care institution between January 2008 and July 2013. Severity of myelopathy was assessed pre- and postoperatively using both the Nurick scale and the modified Japanese Orthopaedic Association (mJOA) classification of disability. Prospectively collected QOL outcomes data included Pain Disability Questionnaire (PDQ), Patient Health Questionnaire–9 (PHQ-9), and EQ-5D. Spearman rank correlations were calculated to assess the construct convergent validity for each pair of health status measures (HSMs). To assess each HSM’s ability to discriminate favorable EQ-5D index, we performed receiver operating characteristic (ROC) curve analysis and assessed the area under the curve (AUC).

RESULTS
A total of 119 patients were included. The PDQ total score had the highest correlation with EQ-5D index (Spearman’s rho = −0.82). Neither of the myelopathy scales (mJOA or Nurick) had strong correlations between themselves (0.41) or with the other QOL measures (absolute value range 0.13–0.49). In contrast, the QOL measures correlated relatively well with each other (absolute value range 0.68–0.97). For predicting favorable EQ-5D outcomes, PDQ total score had an AUC of 0.909. The AUCs were significantly greater for the QOL measures in comparison with the myelopathy measures (AUCs were 0.677 and 0.607 for mJOA and Nurick scale scores, respectively).

CONCLUSIONS
The authors found that all included measures of QOL and CSM-specific (mJOA or Nurick scale) measures were valid and responsive. The PDQ was the most predictive of positive QOL after surgery (as measured by the EQ-5D index) for patients with CSM. The substantially lower correlation between myelopathy and QOL outcomes, compared with the various QOL measures themselves, suggests that these questionnaires are measuring different aspects of the patient experience. Solely assessing the myelopathy or disease-specific signs and symptoms is likely insufficient to fully understand and appreciate clinical outcome in its totality. These questionnaire types should be used together to best evaluate patients pre- and postoperatively.
Mild traumatic brain injury in children is associated with a low risk for posttraumatic seizures
Authors: Huguenard Anna L. , Miller Brandon A. , Sarda Samir , Capasse Meredith , Reisner Andrew , Chern Joshua J. 
Published: November 2015

OBJECT
Of the 1.7 million traumatic brain injuries (TBIs) in the US, a third occur in patients under 14 years of age. The rate of posttraumatic epilepsy (PTE) may be as high as 19% after severe pediatric TBI, but the risk for seizures after mild TBI is unknown. Although the rate of seizures after mild TBI may be low, current practice is often driven by high clinical concern for posttraumatic seizures. In this study, the authors evaluated electroencephalography (EEG) results and antiepileptic drug (AED) use in a large cohort of children with mild TBI to estimate the incidence of posttraumatic seizures in this population.

METHODS
Patients presenting to Children’s Hospital of Atlanta for mild TBI from 2010 to 2013 were evaluated. Five thousand one hundred forty-eight patients with mild TBI were studied and divided into 3 groups: 4168 who were discharged from the emergency department, 868 who were admitted without neurosurgical intervention, and 112 who underwent neurosurgical procedures (craniotomy for hematoma evacuation or elevation of depressed skull fractures) but were discharged without an extended stay. Demographic information, CT characteristics, EEG reports, and prescriptions for AEDs were analyzed. Long-term follow-up was sought for all patients who underwent EEG. Correlation between EEG result and AED use was also evaluated.

RESULTS
All patients underwent head CT, and admitted patients were more likely to have an abnormal study (p < 0.0001). EEG evaluations were performed for less than 1.0% of patients in all 3 categories, without significant differences between groups (p = 0.97). Clinicians prescribed AEDs in less than 2.0% of patients for all groups, without significant differences between groups (p = 0.094). Even fewer children continue to see a neurologist for long-term seizure management. The EEG result had good negative predictive value, but only an abnormal EEG reading that was diagnostic of seizures correlated significantly with AED prescription (p = 0.04).

CONCLUSIONS
EEG utilization and AED prescription was low in all 3 groups, indicating that seizures following mild TBI are likely rare events. EEG has good negative predictive value for patients who did not receive AEDs, but has poorer positive predictive value for AED use.
Clinical significance of changes in pB–C2 distance in patients with Chiari Type I malformations following posterior fossa decompression: a single-institution experience
Authors: Bonney Phillip A. , Maurer Adrian J. , Cheema Ahmed A. , Duong Quyen , Glenn Chad A. , Safavi-Abbasi Sam , Stoner Julie A. , Mapstone Timothy B. 
Published: November 2015

OBJECT
The coexistence of Chiari malformation Type I (CM-I) and ventral brainstem compression (VBSC) has been well documented, but the change in VBSC after posterior fossa decompression (PFD) has undergone little investigation. In this study the authors evaluated VBSC in patients with CM-I and determined the change in VBSC after PFD, correlating changes in VBSC with clinical status and the need for further intervention.

METHODS
Patients who underwent PFD for CM-I by the senior author from November 2005 to January 2013 with complete radiological records were included in the analysis. The following data were obtained: objective measure of VBSC (pB–C2 distance); relationship of odontoid to Chamberlain’s, McGregor’s, McRae’s, and Wackenheim’s lines; clival length; foramen magnum diameter; and basal angle. Statistical analyses were performed using paired t-tests and a mixed-effects ANOVA model.

RESULTS
Thirty-one patients were included in the analysis. The mean age of the cohort was 10.0 years. There was a small but statistically significant increase in pB–C2 postoperatively (0.5 mm, p < 0.0001, mixed-effects ANOVA). Eleven patients had postoperative pB–C2 values greater than 9 mm. The mean distance from the odontoid tip to Wackenheim’s line did not change after PFD, signifying postoperative occipitocervical stability. No patients underwent transoral odontoidectomy or occipitocervical fusion. No patients experienced clinical deterioration after PFD.

CONCLUSIONS
The increase in pB–C2 in patients undergoing PFD may occur as a result of releasing the posterior vector on the ventral dura, allowing it to relax posteriorly. This increase appears to be well-tolerated, and a postoperative pB–C2 measurement of more than 9 mm in light of stable craniocervical metrics and a nonworsened clinical examination does not warrant further intervention.
Single-Blind, Randomized, Controlled Clinical Trial of Exercise in Ambulatory Spinal Muscular Atrophy: Why are the Results Negative?
Authors: Montes Jacqueline , Garber Carol Ewing , Kramer Samantha S. , Montgomery Megan J. , Dunaway Sally , Kamil-Rosenberg Shirit , Carr Brendan , Cruz Rosangel , Strauss Nancy E. , Sproule Douglas , De Vivo Darryl C. 
Published: November 2015

Background: The benefits of exercise on long-term health and well-being are well established. The possible benefits of exercise in Spinal Muscular Atrophy (SMA) have not been explored in a controlled clinical trial format. Objective: To assess the effects of exercise on measures of function, strength, and exercise capacity in ambulatory SMA patients. Methods: Fourteen participants, ages 10–48 years, were randomized to control and exercise cohorts after a 1 month lead-in period. The exercise group received 6 months of intervention. Thereafter, both groups received the intervention for the remaining 12 months. Participants were monitored for a total of 19 months. Exercise included individualized home-based cycling and strengthening. The primary outcome measure was distance walked during the six-minute walk test (6MWT). Secondary outcomes included strength, function, exercise capacity, quality of life and fatigue. Results: Twelve participants completed the first 7 months of the study, and 9 completed all 19 months. At baseline, the groups were similar on all clinical variables. There were no group changes at any time point in the 6MWT, fatigue, or function. Percent-predicted VO2 max improved 4.9% in all participants in 6 months ( p = 0.036) ( n = 10). Conclusion: Daily exercise is safe in ambulatory SMA and should be encouraged. We did not uncover any deleterious effects on strength, function, or fatigue. Our study documented a reduction in oxidative capacity and a blunted conditioning response to exercise possibly representing an important insight into underlying pathophysiological mechanisms. These findings also may be linked causally to mitochondrial depletion in SMA and warrant further study.
Densidade do funcionalismo público da administração direta municipal brasileira na perspectiva da dimensão populacional
Authors: Nychai Luci , Godoy Amália Maria Goldberg , Lombat Maria Luzia 
Published: November 2015

<div>Apesar das recorrentes críticas ao aumento dos gastos do funcionalismo público, o Município é uma </div><div>organização, e como tal depende do quadro de servidores da administração direta para poder funcionar </div><div>e atender às demandas institucionais, sociais e econômicas como Ente Subnacional Federativo. A </div><div>intenção deste artigo é apresentar a densidade do funcionalismo público municipal no Brasil a partir da </div><div>dimensão populacional. A metodologia considerou os dados de corte observados para 2011 e </div><div>agregados por municípios conforme o porte populacional e por grandes regiões geográficas. A análise </div><div>complementar sobre o gasto com pessoal e encargos foi subsidiada pela utilização da proxy do Índice </div><div>Firjan de Gestão Municipal para Gasto com Pessoal e das despesas municipais com pessoal do Finbra. </div><div>Conforme os resultados, o gasto com funcionalismo público da administração direta municipal </div><div>absorveu em média 40,82% da receita corrente, sendo que apenas 7,97% dos municípios brasileiros </div><div>apresentam excelente condição na gestão do gasto com pessoal, abrangendo principalmente os </div><div>pequenos municípios. </div>
Ordenamentos territoriais na sub-bacia do Ribeirão da Velha, Blumenau (SC)
Authors: Kreutzfeld Jonathan , Marimon Maria Paula Casagrande 
Published: November 2015

<p>Este artigo tem por finalidade apresentar<em> </em>a maneira como ocorreu a ocupação da sub-bacia do Ribeirão da Velha. Para atingir este objetivo, foram levantadas as informações referentes aos ordenamentos territoriais que atuaram na sua ocupação. Documentos antigos, legislação e planos diretores foram consultados. A área estudada sofre com problemas hidrológicos e teve seus ordenamentos relacionados com as emergências provenientes destas intempéries. O Ribeirão da Velha está sob a influência de ordenamentos territoriais desde o surgimento da colônia de Blumenau em 1850 e a partir de 1977 é regido por planos diretores.</p>
Políticas públicas de fomento à economia criativa: Curitiba e contexto nacional e internacional
Authors: Procopiuck Mario , Freder Schirlei 
Published: November 2015

O tema “economia criativa” tem ocupado a pauta de diversos governos e de organizações <br />internacionais de forma mais intensa nestes últimos cinco anos. Em estágio pré-paradigmático, são <br />ainda relativamente poucos os pontos de consenso para que possam ser definidas claramente correntes <br />teóricas. Não obstante, estudos se intensificam com vistas a buscar meios operacionais para que a base <br />conceitual existente passe a pautar políticas públicas de desenvolvimento em diferentes contextos <br />locais, nacionais e internacionais. Nesse sentido, modelos sobre economia criativa, classes criativas e <br />cidades criativas têm sido propostos, e vários deles já começam dar origem a resultados empíricos. <br />Nesse sentido, o presente artigo tem como objetivo trazer à reflexão diferentes perspectivas sobre <br />economia criativa, tanto de cunho teórico quanto prático, apresentando o quadro geral das discussões <br />sobre o tema em escala global para, em seguida, analisar estudos que procuram situar o p atamar em <br />que se desenvolve em Curitiba a política pública de fomento à economia criativa.
Planejamento do turismo para o desenvolvimento local
Authors: Silva Marina Duarte Gomes , Miranda Elis De Araújo 
Published: November 2015

Este artigo aborda como o planejamento da atividade turística pode contribuir para o desenvolvimento <br />local, e foi elaborado a partir de uma pesquisa bibliográfica que subsidiou teoricamente as análises do <br />lazer, turismo, planejamento turístico e desenvolviment o local. Com base nos estudos acadêmicos que <br />serviram para nortear esta pesquisa, identificou-se como o turismo está associado ao desenvolvimento <br />do território, e como esse desenvolvimento, primeiramente, deve atender ao bem-estar da população <br />residente, para depois estar adequado para o visitante usufruir do local turístico. Apontou -se como o <br />benefício econômico dessa atividade contribuiu para a inserção do setor nas agendas políticas locais, <br />com elaboração de ações específicas. Buscou-se analisar o planejamento integrado do turismo a <br />diferentes atividades econômicas e sociais. Apontou-se também a importância dos planos setoriais <br />nacionais, regionais e locais estarem conectados para um desenvolvimento adequado do território. <br />Como resultado, observa-se a necessidade de uma educação turística para órgãos públicos, <br />empresários locais e população residente, além da necessidade de um processo participativo da <br />comunidade na elaboração das diretrizes para o aprimoramento do turismo. Dessa maneira, o <br />desenvolvimento local a partir dessa atividade pode alcançar, além da sua finalidade econômica , como <br />o envolvimento de empresas locais, benefícios sociais para as comunidades envolvidas, que terão <br />preservadas suas manifestações culturais, história e meio ecológico local.
Empreendedorismo e desenvolvimento nos municípios paranaenses – uma análise dos indicadores
Authors: Félix Rosana Dalla Costa , Farah Júnior Moisés Francisco 
Published: November 2015

O Brasil é caracterizado por um processo histórico de desenvolvimento concentrado nos grandes <br />centros. As desigualdades regionais se acentuaram com o processo de industrialização no Paraná, <br />indicando que as políticas de atração de investimentos, especialmente na década de 1990, falharam em <br />resolver esse problema. Para evitar o esvaziamento das cidades periféricas e o êxodo para os grandes <br />centros, é necessário que os municípios encontrem meios próprios de se desenvolverem, e o incentivo <br />ao empreendedorismo é considerado um caminho que pode ser adotado como uma política pública<br />pelos prefeitos. Este artigo busca descrever o nível de empreendedorismo dos 399 municípios <br />paranaenses e relacioná-lo com o grau de desenvolvimento socioeconômico de cada localidade. Para <br />verificar este fenômeno, utilizou-se os indicadores de 2010 mesurados pelo Índice de <br />Desenvolvimento Municipal para a Micro e Pequena Empresa (IDMPE) do Sebrae e pelo Índice Firjan <br />de Desenvolvimento Municipal (IFDM) da Firjan. Adotou-se a metodologia de Análise Exploratória <br />de Dados (AED) e o coeficiente de correlação de Pearson. Encontrou-se indicações de uma alta<br />correlação entre as variáveis empreendedorismo (medido pelo Sebrae) e o desenvolvimento local<br />(medido pela Firjan). A correspondência é ainda mais elevada quando se analisa apenas o componente <br />de emprego e renda no IFDM.
Le bourg, l’atelier et le syndicat
Authors: Mischi Julian 
Published: November 2015

Les images associant les territoires ruraux à leur seul volet agricole ou à des espaces dédiés avant tout à la détente pour citadins sont prégnantes. On peut y voir un effet du travail journalistique ou encore de créations artistiques qui confortent les représentations esthétisantes de la ruralité. De telles représentations s’accordent bien avec les expériences de la campagne vécues par la plupart des urbains, touristes de passage ou propriétaires de résidences secondaires. Mais, au-delà de paysages plus ou moins champêtres, la sociologie des campagnes françaises décrit des territoires profondément populaires, où les ouvriers forment le premier groupe d’actifs bien loin devant celui des agriculteurs ou des cadres qui cherchent à se mettre « au vert ». Des territoires qui n’échappent pas aux dynamiques inégalitaires et aux conflits de classes 1 .