bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial
Authors: Abou-Chebl Alex , Yeatts Sharon D. , Yan Bernard , Cockroft Kevin , Goyal Mayank , Jovin Tudor , Khatri Pooja , Meyers Phillip , Spilker Judith , Sugg Rebecca , Wartenberg Katja E. , Tomsick Tom , Broderick Joe , Hill Michael D. 
Published: July 2015

Background and Purpose—
General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.

Methods—
The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.

Results—

Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA;
P
<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52–0.90;
P
=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65–4.91;
P
=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30–0.81;
P
=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18–7.10;
P
<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (
P
=0.32) or symptomatic intracerebral hemorrhage (
P
=0.37).

Conclusions—
GA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00359424.
Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age
Authors: Arntz Renate M. , Rutten-Jacobs Loes C.A. , Maaijwee Noortje A.M. , Schoonderwaldt Hennie C. , Dorresteijn Lucille D.A. , van Dijk Ewoud J. , de Leeuw Frank-Erik 
Published: July 2015

Background and Purpose—
Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality.

Methods—
We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, aged 18 to 50 years. Survival analysis and Cox proportional hazard analysis were used to estimate cumulative mortality and hazard ratios for patients with and without epilepsy.

Results—
After mean follow-up of 12.5 years (SD 8.6), 76 (12.0%) developed poststroke epilepsy. Case fatality was 27.4% for patients with poststroke epilepsy and 2.1% for those without. Poststroke epilepsy was associated with 30-day mortality (hazard ratio, 4.8; 95% confidence interval, 1.7–14.0) and long-term mortality (hazard ratio, 1.8; 95% confidence interval, 1.2–2.9).

Conclusions—
Epilepsy is a common problem after a young stroke and is associated with an increased short-term and long-term mortality.
Politics of fiscal consolidation in Europe: a comparative analysis
Authors: Kickert Walter J.M. , Randma-Liiv Tiina , Savi Riin 
Published: July 2015

The aim of the article is to comparatively describe and explain consolidation measures and political decision-making processes in 14 European countries. The consolidation measures followed a similar pattern. Hiring and pay freeze occurred almost everywhere, whereas more radical cutback measures were introduced only in a limited number of countries. Cutback decision-making was not a one-off event, but consisted of a series of stages, beginning with temporary and small measures and gradually evolving into more serious cutbacks, sometimes arriving at targeted cuts and political priority-setting. The political decision-making was moderate and gradual rather than drastic and swift. Exceptions to this general pattern were the Baltic states as well as those European countries which received financial assistance on the condition of swift and severe cutbacks. Economic factors and supra-national influences primarily explained the size of consolidation measures, whereas domestic political factors turned out to have limited explanatory power. Points for practitioners The comparative analysis of fiscal consolidation in 14 European countries showed that the consolidation measures followed a similar pattern. Hiring and pay freeze occurred almost everywhere, whereas more radical cutback measures were introduced only in the later stages of fiscal consolidation. At the beginning of the crisis, the severity and duration of the crisis were denied and the necessity for serious cutbacks was recognized only later. Exceptions to this general pattern were the Baltic States as well as those European countries which were bailed out on condition of swift and severe cutbacks. The article argues that the political will and capacity of governments to take drastic and targeted measures based on political priority-setting is still a serious need.
Fiscal consolidation in federal Belgium
Authors: Troupin Steve , Steen Trui , Stroobants Jesse 
Published: July 2015

This article analyses fiscal consolidation policy in federal Belgium in the period 2009–14, until the initial 2014 budget. It relies on documentary analysis and interviews to examine the intensity, content and decision-making process of this policy. Explanations for this particular fiscal consolidation policy are looked for in the macro-economic context, the political-administrative system, and external influences. We find generally modest budget cutbacks punctuated by an exceptionally significant budget exercise. This pattern is best explained by the tensions within the Belgian political-administration, generating policy continuity, and by external pressure, that allowed policymakers to overcome these tensions. Points for practitioners Beyond providing insight into the specifics of fiscal consolidation in federal Belgium, this article allows a better understanding of why governments engage in fiscal consolidation the way they do. Emphasizing that fiscal consolidation is an essentially political process influenced by national and international factors, our analysis helps practitioners to understand how national and international arguments can be mobilized in national political contexts to trigger policy changes.
Contextualized measures of public service motivation: the case of Spain
Authors: Ballart Xavier , Riba Clara 
Published: July 2015

Since the initial ‘public service motivation’ concept and measures were developed, various studies have raised concerns with regard to cultural differences. According to previous research trying to supplement the four original dimensions of the original construct with a fifth dimension, this study follows this same strategy, taking into account three aspects of the Napoleonic administrative tradition. The analysis captures one new dimension with political loyalty values, which slightly improves the measurement of public service motivation in that specific context. Points for practitioners Previous research has showed that ‘public service motivation’ has consequences in terms of individual and collective behaviour and, thus, it may contribute to improve organizations. Public service motivation has been related to performance, organizational commitment and job satisfaction, among other attitudes and behaviours. It has also been used by public administrations in job selection processes.
Cartilage Restoration of the Knee
Authors: Mundi Raman , Bedi Asheesh , Chow Linda , Crouch Sarah , Simunovic Nicole , Sibilsky Enselman Elizabeth , Ayeni Olufemi R. 
Published: July 2015

Background: Focal cartilage defects of the knee are a substantial cause of pain and disability in active patients. There has been an emergence of randomized controlled trials evaluating surgical techniques to manage such injuries, including marrow stimulation (MS), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OAT). Purpose: A meta-analysis was conducted to determine if any single technique provides superior clinical results at intermediate follow-up. Study Design: Systematic review and meta-analysis of randomized controlled trials. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched and supplemented with manual searches of PubMed and reference lists. Eligible studies consisted exclusively of randomized controlled trials comparing MS, ACI, or OAT techniques in patients with focal cartilage defects of the knee. The primary outcome of interest was function (Lysholm score, International Knee Documentation Committee score, Knee Osteoarthritis Outcome Score) and pain at 24 months postoperatively. A meta-analysis using standardized mean differences was performed to provide a pooled estimate of effect comparing treatments. Results: A total of 12 eligible randomized trials with a cumulative sample size of 765 patients (62% males) and a mean (±SD) lesion size of 3.9 ± 1.3 cm2 were included in this review. There were 5 trials comparing ACI with MS, 3 comparing ACI with OAT, and 3 evaluating different generations of ACI. In a pooled analysis comparing ACI with MS, there was no difference in outcomes at 24-month follow-up for function (standardized mean difference, 0.47 [95% CI, –0.19 to 1.13]; P = .16) or pain (standardized mean difference, –0.13 [95% CI, –0.39 to 0.13]; P = .33). The comparisons of ACI to OAT or between different generations of ACI were not amenable to pooled analysis. Overall, 5 of the 6 trials concluded that there was no significant difference in functional outcomes between ACI and OAT or between generations of ACI. Conclusion: There is no significant difference between MS, ACI, and OAT in improving function and pain at intermediate-term follow-up. Further randomized trials with long-term outcomes are warranted.
Femoral and Tibial Graft Tunnel Parameters After Transtibial, Anteromedial Portal, and Outside-In Single-Bundle Anterior Cruciate Ligament Reconstruction
Authors: Osti Michael , Krawinkel Alessa , Ostermann Michael , Hoffelner Thomas , Benedetto Karl Peter 
Published: July 2015

Background: Anatomic graft tunnel placement is recommended in anterior cruciate ligament (ACL) reconstruction to restore knee joint stability and function. Transtibial (TT), anteromedial portal (AMP), and outside-in (OI) retrograde drilling surgical techniques have been described for tibial and femoral bone tunnel preparation. Purpose/Hypothesis: The purpose of this study was to evaluate the bone tunnel parameters and compare the ability of 3 different surgical techniques to achieve placement of the ACL femoral and tibial bone tunnels at the center of the native ACL femoral and tibial attachment sites. The hypothesis was that tunnel placement using an AMP or OI technique would result in optimized tunnel parameters and more closely reconstruct the center of the native ACL femoral attachment site. Study Design: Cohort study; Level of evidence, 3. Methods: The study population consisted of 100 patients undergoing anatomic single-bundle ACL reconstruction using multiple-stranded hamstring tendon grafts. In group 1 (n = 36), the femoral tunnel was drilled using a TT surgical technique; in group 2 (n = 32), the femoral tunnel was drilled through an AMP; and in group 3 (n = 32), the femoral tunnel was created by use of an OI technique with retrograde drilling. Computed tomography (CT) scans were obtained postoperatively, and characteristics of femoral and tibial tunnel apertures were correlated to femoral and tibial measurement grid systems. The position of the resulting tibial and femoral bone tunnels for each group was compared with the center of the native ACL attachment sites. Results: There were statistically significant differences ( P < .05) for the ACL femoral tunnel between the 3 groups with respect to intercondylar height, total tunnel length, graft fixation length, tunnel axis, and tunnel entry angle. Statistically significant differences ( P < .05) were found for the ACL tibial tunnel with respect to anteroposterior tunnel position and sagittal tunnel axis between the TT and both the OI and AMP techniques. The OI surgical technique produced more oblique and anatomically correct femoral tunnel apertures and longer femoral tunnel lengths compared with the AMP technique. Both AMP and OI techniques resulted in a more precise replication of intercondylar tunnel depth and height. There was no statistically significant difference for graft fixation length between the AMP and OI techniques. Conclusion: The AMP and OI surgical techniques were superior in positioning the ACL femoral tunnel at the center of the native ACL attachment site compared with the TT technique. An acceptable graft fixation length was obtained for all 3 surgical techniques.
Factors Affecting the Choice and Desire to Exclusively Breastfeed in Jamaica
Authors: Harrison Abigail , Fletcher-Groves Shani , Gordon-Strachan Georgiana , Thame Minerva 
Published: July 2015

Background: Exclusive breastfeeding rates (EBRs) may be influenced by sociodemographic and sociocultural factors, including maternal age, socioeconomic status, education, and breastfeeding knowledge. The EBR in Jamaica has been low and declining, leaving a need for better determination of the specific local contributory factors. Objectives: This study aimed to better elucidate the factors that influence mothers exclusively breastfeeding, including antenatal intentions to breastfeed, mothers’ knowledge of the benefits of breastfeeding, and mothers’ infant feeding practices in general, inclusive of breastfeeding, formula feeding, and complementary feeding. Methods: A cross-sectional survey was conducted using a 52-item interviewer-administered questionnaire with mothers attending their 6-week postnatal clinic visit. Sociodemographic data were collected on all participants as well as data regarding participants’ breastfeeding knowledge, attitudes, and practices. Statistical analyses were done using χ2 tests, t tests, and risk analyses. Results: Two hundred participants were interviewed; the mean ± SD age of participants was 26.2 ± 6.46 years (range, 15-46 years). The EBR in this study sample was 32%. Sociodemographic factors, including maternal age and socioeconomic status, as well as antenatal and postnatal breastfeeding sessions, did not significantly affect the likelihood of exclusively breastfeeding at 6 weeks postpartum. The only factor significantly associated with the EBR was mothers’ belief that exclusively breastfeeding was able to ensure infant satiety. Conclusion: Antenatal and postnatal breastfeeding sessions should place more emphasis on dispelling maternal myths and misperceptions regarding signs of satiety and hunger in infants and reinforcing the knowledge that breast milk alone is sufficient for the first 6 months of life.
Marriage equality is a mental health issue
Authors: Kealy-Bateman Warren , Pryor Lisa 
Published: July 2015

Objective: We aim to review marriage equality in New Zealand and Australia and critically evaluate the health impact of such a legal change. Method: We undertook a review of the literature using the search terms “marriage equality”, “same sex marriage” and “gay marriage” in combination with “health”, “wellbeing”, “psych*”, “mental illness” and “distress”. This search included medical literature, legal literature and mass media. Results: This review indicates that Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people disproportionately face negative health stressors and negative health events compared with the general population and this is related to the stress of being a stigmatised minority group. The evidence strongly supports the proposition that marriage equality is related to improved health outcomes. A diverse range of professional health groups advocate for the legislative progression to marriage equality. The authors found no evidence that marriage equality harms opposite-sex marriage. Conclusion: Marriage equality is still lacking in Australia and as a positive correlate of health should be strongly supported.
What happens to episode duration and cycle length over the course of bipolar disorder?
Authors: Subramanian Karthick , Kattimani Shivanand , Rajkumar Ravi P , Bharadwaj Balaji , Sarkar Siddharth 
Published: July 2015

Objectives: Published scientific literature on cycle acceleration over the course of bipolar disorder has been equivocal. The present analysis aimed to find whether episode duration and cycle lengths become shorter over the course of bipolar disorder with predominantly manic polarity. Methods: The present study comprised 150 patients diagnosed with bipolar I disorder using SCID-I for DSM-IV TR. The course of illness was charted according to the NIMH Life Chart Methodology – Clinician Retrospective Chart (NIMH – LCM CRC). Spearman correlation was used to assess the relationship of episode duration and cycle length with the number of episodes. Results: The mean age of the sample was 37.8 years and the average duration of illness was 13.4 years. Unipolar mania comprised 52.7% of the sample. The episode duration and the cycle length decreased with increasing number of episodes ( r=−0.245, p<0.001 & r=−0.299, p<0.001 respectively). Conclusion: The present study suggests that over the course of bipolar I disorder, cycle length and episode duration become shorter.
Provider Difficulties With Spiritual and Forgiveness Communication at the End of Life
Authors: Wittenberg Elaine , Ferrell Betty , Goldsmith Joy , Buller Haley 
Published: July 2015

Background: Due to an absence of communication training, provider responses to patient/family spiritual distress are highly variable. Assessing spiritual and forgiveness concerns are important to ensuring quality holistic care. Methods: Cross-sectional survey data were collected from providers attending 1 of 2 continuing education courses. The survey measured the frequency and initiation of communication about spirituality and forgiveness with patients/families, the perceived difficulty in communication across topics, and preparation and resources for these discussions. Results: Most participants (n = 124) were nurses followed by social workers with over half of providers having 10 years or more of clinical experience. Participants reported the highest level of difficulty in spiritual communication when talking with family after the death of a patient, followed by conducting a spiritual history with a patient. Facilitating forgiveness communication between parent and adult child, followed by facilitating forgiveness between partners was most difficult for all participants. Social workers reported much lower difficulty than nurses on all items of spiritual and forgiveness communication. Conclusion: The majority of participants indicated they were involved in spiritual and forgiveness communication. The most difficult communication included talking with family after death and facilitating forgiveness between patients and families. These findings support the importance of spiritual communication in clinical practice, and the need for clinician training in communicating about spirituality and forgiveness with patients and families.
Assessment of a quantitative 5' nuclease real-time polymerase chain reaction using the nicotinamide adenine dinucleotide dehydrogenase gamma subunit (nuoG) for Bartonella species in domiciled and stray cats in Brazil
Authors: André Marcos Rogério , Dumler John Stephen , Herrera Heitor M , Gonçalves Luiz R , de Sousa Keyla CM , Scorpio Diana Gerardi , de Santis Ana Cláudia Gabriela Alexandre , Domingos Iara Helena , de Macedo Gabriel Carvalho , Machado Rosangela Zacarias 
Published: July 2015

Objectives The objective of this study was to develop a quantitative 5' nuclease real-time polymerase chain reaction (PCR) assay to diagnose infections caused by Bartonella species. Methods Between January and April 2013 whole blood samples were collected by convenience from 151 cats (86 domiciled and 65 stray cats). The feline blood samples were subjected to a novel quantitative 5' nuclease real-time PCR (qPCR) for Bartonella species targeting the nictonamide adenine dinucleotide dehydrogenase gamma subunit ( nuoG) and conventional PCR assays targeting intergenic transcribed spacer, ribC, gltA, pap31 and rpoB, followed by sequencing and basic local alignment search tool analysis. Results The qPCR assay detected as few as 10 copies of plasmid per reaction. Forty-six (54.4% domiciled and 45.6% stray cats) of 151 sampled cats showed positive results in nuoG qPCR for Bartonella species. The absolute quantification of nuoG Bartonella DNA in sampled cats ranged from 1.1 × 104 to 1.3 × 104. Eighteen (39.1%) of 46 positive samples in the qPCR were also positive in conventional PCR assays. The sequencing confirmed that Bartonella henselae and Bartonella clarridgeiae circulate in cats in midwestern Brazil. Conclusions and relevance The present work provides details of a novel qPCR assay to diagnose infections caused by Bartonella species.
Feasibility and Acceptability of Cryptococcal Antigen Screening and Prevalence of Cryptocococcemia in Patients Attending a Resource-Limited HIV/AIDS Clinic in Malawi
Authors: Chipungu Chifundo , Veltman Jennifer A. , Jansen Perry , Chiliko Peter , Lossa Christina , Namarika Dan , Benner Blake , Hoffman Risa M. , Bristow Claire C. , Klausner Jeffrey D. 
Published: July 2015

Background: The World Health Organization (WHO) recommends screening patients living with AIDS to detect and treat early cryptococcal infection. Methods: The authors evaluated a cryptococcal antigen (CrAg) screening and treatment program at an HIV/AIDS clinic in Malawi. Eligible patients were of age >18 years, had a CD4 count <100 cells/µL or WHO clinical HIV/AIDS stage III or IV. Results: Of 552 patients who presented for care, 113 were eligible, and all (100%) agreed to CrAg screening. Of them, 2 (1.8%; 95% confidence interval [CI]: 0-4.2%) patients were CrAg positive. Among those with CD4 count <100 cells/µL or WHO stage IV, the CrAg prevalence was 3.5% (95% CI: 0-8.4%) and 5.0% (95% CI: 0-15%), respectively. Conclusion: A CrAg screening program was acceptable to new patients in a Malawian HIV/AIDS clinic. The CrAg prevalence for patients with CD4 count < 100 cells/µL and WHO stage IV was consistent with cost-effectiveness estimates. CrAg screening and treatment programs for patients living with AIDS should be expanded.
The antigenic landscape of multiple myeloma: mass spectrometry (re)defines targets for T-cell–based immunotherapy
Authors: Walz Simon , Stickel Juliane S. , Kowalewski Daniel Johannes , Schuster Heiko , Weisel Katja , Backert Linus , Kahn Stefan , Nelde Annika , Stroh Tatjana , Handel Martin , Kohlbacher Oliver , Kanz Lothar , Salih Helmut Rainer , Rammensee Hans-Georg , Stevanović Stefan 
Published: July 2015

Key Points
Direct analysis of the HLA-presented peptidome identifies a distinct antigenic signature in MM. T-cell responses for these antigens are detectable exclusively in MM patients and can be induced in vitro in response-naive patients.