bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploration of Time-Course Combinations of Outcome Scales for Use in a Global Test of Stroke Recovery
Authors: Goldie Fraser C. , Fulton Rachael L. , Dawson Jesse , Bluhmki Erich , Lees Kennedy R. 
Published: October 2013

Background Clinical trials for acute ischemic stroke treatment require large numbers of participants and are expensive to conduct. Methods that enhance statistical power are therefore desirable. Aims We explored whether this can be achieved by a measure incorporating both early and late measures of outcome (e.g. seven-day NIH Stroke Scale combined with 90-day modified Rankin scale). Methods We analyzed sensitivity to treatment effect, using proportional odds logistic regression for ordinal scales and generalized estimating equation method for global outcomes, with all analyses adjusted for baseline severity and age. We ran simulations to assess relations between sample size and power for ordinal scales and corresponding global outcomes. We used R version 2·12·1 (R Development Core Team. R Foundation for Statistical Computing, Vienna, Austria) for simulations and SAS 9·2 (SAS Institute Inc., Cary, NC, USA) for all other analyses. Results Each scale considered for combination was sensitive to treatment effect in isolation. The mRS90 and NIHSS90 had adjusted odds ratio of 1·56 and 1·62, respectively. Adjusted odds ratio for global outcomes of the combination of mRS90 with NIHSS7 and NIHSS90 with NIHSS7 were 1·69 and 1·73, respectively. The smallest sample sizes required to generate statistical power ≥80% for mRS90, NIHSS7, and global outcomes of mRS90 and NIHSS7 combined and NIHSS90 and NIHSS7 combined were 500, 490, 400, and 380, respectively. Discussion When data concerning both early and late outcomes are combined into a global measure, there is increased sensitivity to treatment effect compared with solitary ordinal scales. This delivers a 20% reduction in required sample size at 80% power. Combining early with late outcomes merits further consideration.
Establishment of an Effective Acute Stroke Telemedicine Program for Australia: Protocol for the Victorian Stroke Telemedicine Project
Authors: Cadilhac Dominique A. , Moloczij Natasha , Denisenko Sonia , Dewey Helen , Disler Peter , Winzar Bruce , Mosley Ian , Donnan Geoffrey A. , Bladin Christopher 
Published: October 2013

Rationale Urgent treatment of acute stroke in rural Australia is problematic partly because of limited access to medical specialists. Utilization of telemedicine could improve delivery of acute stroke treatments in rural communities. Aim The study aims to demonstrate enhanced clinical decision making for use of thrombolysis within 4·5 h of ischemic stroke symptom onset in a rural setting using a telemedicine specialist support model. Design A formative program evaluation research design was used. The Victorian Stroke Telemedicine program was developed and will be evaluated over five stages to ensure successful implementation. The phases include: (a) preimplementation phase to establish the Victorian Stroke Telemedicine program including the clinical pathway, data collection tools, and technology processes; (b) pilot clinical application phase to test the pathway in up to 10 patients; (c) modification phase to refine the program; (d) full clinical implementation phase where the program is maintained for one-year; and (e) a sustainability phase to assess project outcomes over five-years. Qualitative (clinician interviews) and quantitative data (patient, clinician, costs, and technology processes) are collected in each phase. Study outcomes The primary outcome is to achieve a minimum 10% absolute increase in eligible patients treated with thrombolysis. Secondary outcomes are utilization of the telestroke pathway and improvements in processes of stroke care (e.g., time to brain scan). We will report door to telemedicine consultation time, length of telemedicine consultation, clinical utility and acceptability from the perspective of clinicians, and 90-day patient outcomes. Summary This research will provide evidence for an effective telestroke program for use in regional Australian hospitals.
Gender Differences in the Age-Stratified Prevalence of Risk Factors in Korean Ischemic Stroke Patients: A Nationwide Stroke Registry-Based Cross-Sectional Study
Authors: Park Tai Hwan , Ko Youngchai , Lee Soo Joo , Lee Kyung Bok , Lee Jun , Han Moon-Ku , Park Jong-Moo , Kim Dong-Eog , Cho Yong-Jin , Hong Keun-Sik , Kim Joon-Tae , Cho Ki-Hyun , Kim Dae-Hyun , Cha Jae-Kwan , Yu Kyung-Ho , Lee Byung-Chul , Yoon Byung-Woo , Lee Ji Sung , Lee Juneyoung , Gorelick Philip B. , Bae Hee-Joon 
Published: October 2013

Background Although ethnic or cultural differences affect prevalence of cardiovascular risk factors, limited information is available about the age- and gender-stratified prevalence of the risk factors in Asian stroke population. Aims and hypothesis We assessed gender- and age-stratified prevalences of major risk factors in Korean stroke patients, and assumed that the gender differences are attenuated by adjustment with lifestyle factors. Methods Using the nationwide hospital-based stroke registry, we identified 9417 ischemic stroke patients admitted between April 2008 and January 2011. Prevalence of hypertension, diabetes, hyperlipidemia, atrial fibrillation, prior stroke, and coronary heart disease was assessed in both genders by age groups. We analyzed gender differences of the prevalence among the age groups by calculating prevalence ratio, and further explored the influence of lifestyle factors on the gender difference in multivariable analyses. Results Hypertension and hyperlipidemia were more common in men until middle age, but after that more common in women, whereas diabetes was more common in women after 65 years of age. Atrial fibrillation increased steadily with age in both genders but was more common in women through all age groups. Prior stroke and coronary heart disease showed inconsistent gender differences. Gender differences in hypertension and diabetes among the age groups were attenuated by adjustment with accompanying risk factors including lifestyle factors. Conclusion Korean women with stroke had more hypertension and hyperlipidemia after middle age, more diabetes after 65 years, and more atrial fibrillation throughout all ages. Strategies to control risk factors in women at risk for stroke are eagerly needed.
Body Mass Index and Acute Ischemic Stroke Outcomes
Authors: Saini M. , Saqqur M. , Shuaib A. 
Published: October 2013

Background The impact of body mass index on acute ischemic stroke outcomes is unclear. Aims and/or hypothesis We sought to determine the effect of body mass index on short-term (90 days) acute ischemic stroke outcomes. Methods Data were extracted for patients with acute ischemic stroke and records of body mass index at baseline from the Virtual International Stroke Trials Archive database. Multivariate logistic regression and Cox proportional hazard analysis were used to analyze effect of body mass index on poor functional outcome (modified Rankin Scale >2) and mortality, respectively, within 90 days of stroke's onset. Results Of the 4811 patients (mean age 68·8 ± 12·2 years) included in the study, 2002 (41·6%) were overweight, and 1095 (22·8%) were obese. Overweight (body mass index 25–29·9 kg/m2) was associated with decreased mortality (hazard ratios 0·59; 95% confidence interval 0·51–0·68; P < 0·01) and decrease in poor functional outcome (odds ratio 0·74; 95% confidence interval 0·64–0·85; P < 0·01) following acute ischemic stroke. The association of body mass index with stroke outcomes was dependent on age, gender, and use of thrombolytic therapy. Conclusions Being overweight or obese is associated with a better functional outcome and reduced mortality in patients of acute ischemic stroke. However, the definition of an ‘optimal’ body mass index, in relation to stroke outcomes, may be affected by age, gender, and use of thrombolytic therapy.
Insiders or outsiders? Mental health service users' journeys towards full citizenship
Authors: Hamer Helen P. , Finlayson Mary , Warren Helen 
Published: October 2013

AbstractThe present study explores the journeys towards full citizenship for those using mental health services as they lobbied to be included as full citizens with the same rights and responsibilities as others in society. Qualitative data were collected through semistructured interviews with 17 service users, five government representatives, and seven registered mental health nurses. A conceptual framework of citizenship containing four domains – the extent, content, depth and acts of citizenship – was used to analyse the data. This paper reports the findings from the service users' data in the first domain, the extent of citizenship, defined as the rules and norms of inclusion and exclusion. The degree to which the service user participants were accepted as full citizens with the same civil, political, and social rights as others was contingent on their ability to adopt their society's rules and norms and appear as ‘normal’ citizens. Participants often experienced being ‘othered’ and excluded from the many rights and responsibilities of citizenship due to society's perception that service users lack certain attributes of normal, productive citizens. Participants reported that being labelled with a mental illness led to them being marginalized and ostracized, thus placing conditions and barriers on their citizenship status. Findings show that in response to experiencing conditional citizenship, participants shaped their behaviour to assimilate with other citizens. As well, they engaged in practices of inclusion to challenge and broaden the social rules and norms in order to be accepted without disavowing their differences.
The Consequences of Substituting Sand with Used Copper Slag in Construction
Authors: Kua Harn Wei 
Published: October 2013

SummaryUsing waste copper slag (CS) as a replacement for sand in concrete mixture is becoming popular in Singapore and around the world. What are the consequences of this material substitution? Will this result in lower environmental impact? This work used attributional and consequential life cycle assessments to evaluate the net results of replacing sand with CS. Impacts were assessed with respect to embodied energy and greenhouse gas emissions (global warming potential; GWP). It was found that embodied energy and GWP of using a combination of 0.13 kilograms (kg) of CS and 0.9 kg of sand are higher than those of 1 kg of sand. If CS replaces sand and the leftover sand replaces crushed rock sand, the net embodied energy and GWP may also increase. Landfilling the waste CS is similar to recycling it as a building material, in terms of embodied energy incurred and GWPs. Finally, four lessons from these findings were used to suggest a few integrated sustainable resource management policies for the building material and shipping industries.
Prospective antifungal therapy (PATH) alliance®: focus on mucormycosis
Authors: Kontoyiannis Dimitrios P. , Azie Nkechi , Franks Billy , Horn David L. 
Published: October 2013

SummaryMucormycosis is increasingly encountered in immunosuppressed patients, such as those with haematological malignancies or stem cell transplantation. We present a descriptive analysis of 121 cases of mucormycosis from the Prospective Antifungal Therapy Alliance® registry (July 2004 to December 2008). Patients with proven or probable mucormycosis were enrolled and followed prospectively for 12 weeks. The most common underlying disease and site of infection were haematologic malignancy (61.2%) and lungs (46.3%) respectively. Rhizopus (n = 63; 52.1%) was the most commonly isolated species, followed by Mucor (n = 28; 23.1%), other or unknown (n = 17; 14.0%), Rhizomucor (n = 9; 7.4%) and Lichtheimia (n = 4; 3.3%). The 12‐week Kaplan–Meier survival probability for all patients was 0.41; however, there was large variation in survival probabilities between species, with highest survival probability observed for Lichtheimia (0.5), followed by Rhizopus (0.47), Mucor (0.40), unknown Mucormycetes species (0.40), other Mucormycetes species (0.17) and Rhizomucor (0.15). Prior use of voriconazole decreased 12‐week survival probability. Survival probability was higher in patients receiving amphotericin B by Day 3 (0.72) vs. those who started amphotericin B therapy after Day 3 (0.33). The low survival probability observed underscores the importance of further studies of mucormycosis. Optimal treatment selection and timing may improve prognosis.
Reactivation of Chagas disease in a bone marrow transplant patient: case report and review of screening and management
Authors: Guiang K.M.U. , Cantey P. , Montgomery S.P. , Ailawadhi S. , Qvarnstrom Y. , Price T. , Blodget E. 
Published: October 2013

AbstractWe report a patient with an autologous stem cell transplant and history of residence in a Chagas disease (CD) endemic area who developed Chagas reactivation after induction for transplantation. We recommend that patients at risk for CD be screened before transplantation, and patients found to have chronic infection be monitored for reactivation post transplant.
Efficacy of Deferasirox for the treatment of iron overload in Chinese thalassaemia major patients: results from a prospective, open‐label, multicentre clinical trial
Authors: Lai Y.‐R. , Liu R.‐R. , Li C.‐F. , Huang S.‐L. , Li Q. , Habr D. , Martin N. , Shen Z.‐X. 
Published: October 2013

SUMMARYObjectiveTo assess the efficacy and safety of deferasirox in Chinese thalassaemia major (TM) patientsBackgroundEPIC (Evaluation of Patients' Iron Chelation with Exjade®) was a large multi‐national study and, notably, the first clinical trial of an iron chelator registered with the Chinese State Food and Drug Administration.MethodsEfficacy and safety of deferasirox were compared in Chinese (n = 117) and non‐Chinese (n = 998) TM patients. Deferasirox was initiated at 20 mg kg−1 day−1, with titration increments of 5−10 mg kg−1day−1, based on serum ferritin trends and safety parameters.ResultsAt baseline, Chinese patients were younger than non‐Chinese (mean age 6·8 versus 19·5 years), with higher median serum ferritin (4519 vs 3058 ng mL−1). Over 1 year, mean actual deferasirox dose was similar for Chinese and non‐Chinese patients (24·6 and 24·0 mg kg−1 day−1, respectively); median serum ferritin did not change significantly from baseline in Chinese patients (+340 ng mL−1, P = 0·102) and significantly decreased in non‐Chinese patients (−220 ng mL−1; P < 0·001). In the 1‐year extension in Chinese patients, (mean actual deferasirox dose 33·6 mg kg−1 day−1), median serum ferritin decreased (−756 ng mL−1; P = 0·0397), with a numerically higher reduction in patients aged ≥6 to  < 12 than <6 years (−982 vs −457 ng mL−1, respectively). The safety profile of deferasirox in Chinese patients was similar to the overall population with respect to clinically‐relevant findings.ConclusionAge and deferasirox exposure influenced study findings, supporting the need for longer‐term treatment and dose escalation to ≥30 mg kg−1 day−1 to achieve neutral or negative iron balance in heavily iron overloaded and younger Chinese patients.
Infectious Bronchitis Virus Generates Spherules from Zippered Endoplasmic Reticulum Membranes
Authors: Maier Helena J. , Hawes Philippa C. , Cottam Eleanor M. , Mantell Judith , Verkade Paul , Monaghan Paul , Wileman Tom , Britton Paul 
Published: October 2013

ABSTRACT

Replication of positive-sense RNA viruses is associated with the rearrangement of cellular membranes. Previous work on the infection of tissue culture cell lines with the betacoronaviruses mouse hepatitis virus and severe acute respiratory syndrome coronavirus (SARS-CoV) showed that they generate double-membrane vesicles (DMVs) and convoluted membranes as part of a reticular membrane network. Here we describe a detailed study of the membrane rearrangements induced by the avian gammacoronavirus infectious bronchitis virus (IBV) in a mammalian cell line but also in primary avian cells and in epithelial cells of
ex vivo
tracheal organ cultures. In all cell types, structures novel to IBV infection were identified that we have termed zippered endoplasmic reticulum (ER) and spherules. Zippered ER lacked luminal space, suggesting zippering of ER cisternae, while spherules appeared as uniform invaginations of zippered ER. Electron tomography showed that IBV-induced spherules are tethered to the zippered ER and that there is a channel connecting the interior of the spherule with the cytoplasm, a feature thought to be necessary for sites of RNA synthesis but not seen previously for membrane rearrangements induced by coronaviruses. We also identified DMVs in IBV-infected cells that were observed as single individual DMVs or were connected to the ER via their outer membrane but not to the zippered ER. Interestingly, IBV-induced spherules strongly resemble confirmed sites of RNA synthesis for alphaviruses, nodaviruses, and bromoviruses, which may indicate similar strategies of IBV and these diverse viruses for the assembly of RNA replication complexes.

IMPORTANCE
All positive-sense single-stranded RNA viruses induce rearranged cellular membranes, providing a platform for viral replication complex assembly and protecting viral RNA from cellular defenses. We have studied the membrane rearrangements induced by an important poultry pathogen, the gammacoronavirus infectious bronchitis virus (IBV). Previous work studying closely related betacoronaviruses identified double-membrane vesicles (DMVs) and convoluted membranes (CMs) derived from the endoplasmic reticulum (ER) in infected cells. However, the role of DMVs and CMs in viral RNA synthesis remains unclear because these sealed vesicles lack a means of delivering viral RNA to the cytoplasm. Here, we characterized structures novel to IBV infection: zippered ER and small vesicles tethered to the zippered ER termed spherules. Significantly, spherules contain a channel connecting their interior to the cytoplasm and strongly resemble confirmed sites of RNA synthesis for other positive-sense RNA viruses, making them ideal candidates for the site of IBV RNA synthesis.
Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit
Authors: Aguado-Lorenzo Virginia , Weeks Kevin , Tunstell Paul , Turnock Karen , Watts Timothy , Arenas-Lopez Sara 
Published: October 2013

ObjectiveTo investigate the accuracy of morphine infusions prepared for neonates in relation to the label strength and to identify the differences in deviation between infusions made in neonatal intensive care unit (NICU) and those dispensed ready-to-use from pharmacy.MethodsUnused portions of morphine solution for infusion were collected over a 6-weeks period and used to determine the concentration of the drug by high-performance liquid chromatography (HPLC).ResultsA total of 19.2% of infusions prepared by nurses in the ward and 7.8% prepared in the pharmacy were outside the limit required by the British Pharmacopoeia (±7.5%). Moreover, a deviation in concentration of more than 20% was found in ward-prepared infusions, although this was caused by volume discrepancies of less than 0.2 mL. The frequency and magnitude of deviations found in infusions prepared in pharmacy was lower than in those prepared by NICU. The latter showed significantly higher number of out-of-specification samples (p=0.015); however, deviations from intended concentration occurred in both settings. Significant differences between pharmacy and NICU for volumes of less than 0.5 mL or for less than 1 mL were not identified probably due to small sample size, but statistical data show a trend for differences.ConclusionsCurrent practice of preparation of infusions from strengths intended for older children and adults involves dilution of small volumes in a syringe and leads to inaccuracy in the final concentration of infusions for neonatal use. We propose the implementation of standard concentrations for this patient group to effectively eliminate these errors.
Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training
Authors: Härgestam Maria , Lindkvist Marie , Brulin Christine , Jacobsson Maritha , Hultin Magnus 
Published: October 2013

ObjectivesInvestigate the use of call-out (CO) and closed-loop communication (CLC) during a simulated emergency situation, and its relation to profession, age, gender, ethnicity, years in profession, educational experience, work experience and leadership style.DesignExploratory study.SettingIn situ simulator-based interdisciplinary team training using trauma cases at an emergency department.ParticipantsThe result was based on 16 trauma teams with a total of 96 participants. Each team consisted of two physicians, two registered nurses and two enrolled nurses, identical to a standard trauma team.ResultsThe results in this study showed that the use of CO and CLC in trauma teams was limited, with an average of 20 CO and 2.8 CLC/team. Previous participation in trauma team training did not increase the frequency of use of CLC while ≥2 structured trauma courses correlated with increased use of CLC (risk ratio (RR) 3.17, CI 1.22 to 8.24). All professions in the trauma team were observed to initiate and terminate CLC (except for the enrolled nurse from the operation theatre). The frequency of team members’ use of CLC increased significantly with an egalitarian leadership style (RR 1.14, CI 1.04 to 1.26).ConclusionsThis study showed that despite focus on the importance of communication in terms of CO and CLC, the difficulty in achieving safe and reliable verbal communication within the interdisciplinary team remained. This finding indicates the need for validated training models combined with further implementation studies.
Spinal cord stimulators in an outpatient interventional neuroradiology practice
Authors: Padwal Jennifer , Georgy Mark M , Georgy Bassem A 
Published: October 2013

PurposeSpinal cord stimulation is a known modality for the treatment of chronic back and neck pain. Traditionally, spine surgeons and pain physicians perform the procedures. We report our experience in performing neuromodulation procedures in an outpatient interventional neuroradiology practice.MethodsA retrospective analysis of medical records of all trial and permanent implantation patients over a period of 4 years was performed. 45 patients (32 men) of median age 47 years were included in the study. The primary diagnoses were 23 cases of failed back or neck surgery syndrome, 12 cases of spinal stenosis, 4 cases of axial pain, 3 cases with reflex sympathetic dystrophy, 1 case of peripheral vascular disease, 1 case of phantom limb and 1 case of post-concussion syndrome.ResultsThirty-four trials were performed in an outpatient clinic while 11 trials were performed in hospital outpatient settings. Trial periods were 3–7 days. 27 patients (60%) who reported ≥50% pain relief underwent a permanent implantation. An interventional neuroradiologist performed 17 implantations, while spine surgeons performed 10 implantations. 23 implants were epidural (19 lumbar and 4 cervical) and four implants were subcutaneous. During the follow-up period, three patients had infections (13%) and required removal of the device and two cases (8%) reported lead migration.ConclusionsNeuromodulation procedures can be performed safely in an outpatient interventional radiology setting. Although the infection rate was relatively higher in this study population, the other complication rates and trial-to-implant ratio are similar to published data.