bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Avoidance Associated With Optimal Stroke Care in Canada
Authors: Krueger Hans , Lindsay Patrice , Cote Robert , Kapral Moira K. , Kaczorowski Janusz , Hill Michael D. 
Published: May 2012

Background and Purpose—
Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion.

Methods—
Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008–2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided.

Results—
Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs).

Conclusions—
The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.
Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients
Authors: Chumbler Neale R. , Quigley Patricia , Li Xinli , Morey Miriam , Rose Dorian , Sanford Jon , Griffiths Patricia , Hoenig Helen 
Published: May 2012

Background and Purpose—
To determine the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on physical function, and secondarily on disability, in veterans poststroke.

Methods—
We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers. Veterans with a stroke in the preceding 24 months were randomized to the STeleR intervention or usual care. The STeleR intervention consisted of 3 home visits, 5 telephone calls, and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies. Usual care participants received routine rehabilitation care as prescribed by their physicians. The primary outcome measures were improvement in function at 6 months, measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument.

Results—

The 2 complementary primary outcomes (Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure) improved at 6 months for the STeleR group and declined for the usual care group, but the differences were not statistically significant (
P
=0.25, Late-Life Function and Disability Instrument;
P
=0.316). Several of secondary outcomes were statistically significant. At 6 months, compared with the usual care group, the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales (
P
<0.05), and approached significance in 1 of the 3 Function component subscales (
P
=0.06).

Conclusions—
The STeleR intervention significantly improved physical function, with improvements persisting up to 3 months after completing the intervention. STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited resources available for in-home rehabilitation for stroke survivors.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00384748.
Head and Neck Cooling Decreases Tympanic and Skin Temperature, But Significantly Increases Blood Pressure
Authors: Koehn Julia , Kollmar Rainer , Cimpianu Camelia-Lucia , Kallmünzer Bernd , Moeller Sebastian , Schwab Stefan , Hilz Max J. 
Published: May 2012

Background and Purpose—
Localized head and neck cooling might be suited to induce therapeutic hypothermia in acute brain injury such as stroke. Safety issues of head and neck cooling are undetermined and may include cardiovascular autonomic side effects that were identified in this study.

Methods—

Ten healthy men (age 35±13 years) underwent 120 minutes of combined head and neck cooling (Sovika, HVM Medical). Before and after onset of cooling, after 60 and 120 minutes, we determined rectal, tympanic, and forehead skin temperatures, RR intervals, systolic and diastolic blood pressures (BP), laser-Doppler skin blood flow at the index finger and cheek, and spectral powers of mainly sympathetic low-frequency (0.04–0.15 Hz) and parasympathetic high-frequency (0.15–0.5 Hz) RR interval oscillations and sympathetic low-frequency oscillations of BP. We compared values before and during cooling using analysis of variance with post hoc analysis; (significance,
P
<0.05).

Results—

Forehead skin temperature dropped by 5.5±2.2°C with cooling onset and by 12.4±3.2°C after 20 minutes. Tympanic temperature decreased by 4.7±0.7°C within 40 minutes, and rectal temperature by only 0.3±0.3°C after 120 minutes. Systolic and diastolic BP increased immediately on cooling onset and rose by 15.3±20.8 mm Hg and 16.5±13.4 mm Hg (
P
=0.004) after 120 minutes, whereas skin blood flow fell significantly during cooling. RR intervals and parasympathetic RR interval high-frequency powers increased with cooling onset and were significantly higher after 60 and 120 minutes than they were before cooling.

Conclusions—
Head and neck cooling prominently reduced tympanic temperature and thus might also induce intracerebral hypothermia; however, it did not significantly lower body core temperature. Profound skin temperature decrease induced sympathetically mediated peripheral vasoconstriction and prominent BP increases that are not offset by simultaneous parasympathetic heart rate slowing. Prominent peripheral vasoconstriction and BP increase must be considered as possibly harmful during head and neck cooling.
Response Suppression by Automatic Retrieval of Stimulus–Stop Association: Evidence from Transcranial Magnetic Stimulation
Authors: Chiu Yu-Chin , Aron Adam R. , Verbruggen Frederick 
Published: May 2012

Abstract
Behavioral studies show that subjects respond more slowly to stimuli to which they previously stopped. This response slowing could be explained by “automatic inhibition” (i.e., the reinstantiation of motor suppression when a stimulus retrieves a stop association). Here we tested this using TMS. In Experiment 1, participants were trained to go or no-go to stimuli. Then, in a test phase, we compared the corticospinal excitability for go stimuli that were previously associated with stopping (no-go_then_go) with go stimuli that were previously associated with going (go_then_go). Corticospinal excitability was reduced for no-go_then_go compared with go_then_go stimuli at a mere 100 msec poststimulus. Although these results fit with automatic inhibition, there was, surprisingly, no suppression for no-go_then_no-go stimuli, although this should occur. We speculated that automatic inhibition lies within a continuum between effortful top–down response inhibition and no inhibition at all. When the need for executive control and active response suppression disappears, so does the manifestation of automatic inhibition. Therefore, it should emerge during go/no-go learning and disappear as performance asymptotes. Consistent with this idea, in Experiment 2, we demonstrated reduced corticospinal excitability for no-go versus go trials most prominently in the midphase of training but it wears off as performance asymptotes. We thus provide neurophysiological evidence for an inhibition mechanism that is automatically reinstantiated when a stimulus retrieves a learned stopping episode, but only in an executive context in which active suppression is required. This demonstrates that automatic and top–down inhibition jointly contribute to goal-directed behavior.
Longitudinal Tracheoesophageal Puncture Size Stability
Authors: Lundy Donna S. , Landera Mario A. , Bremekamp Jocelyn , Weed Donald 
Published: May 2012

ObjectiveThe purpose of this study is to investigate prosthesis size stability over time and determine which factors influence need for change in size.Study DesignRetrospective chart review.SettingTeaching hospital.Subjects and MethodsRetrospective chart review was performed on all individuals who had previously undergone total laryngectomy and tracheoesophageal puncture and had a minimum of 3 years of consistent and consecutive follow‐up data after their prosthesis was initially placed. Data reviewed included demographic variables of age at time of tracheoesophageal puncture, ethnicity, and sex.ResultsFifty patients were identified who met criteria for study inclusion with a mean age of 64.7 years (range, 43‐86 years) with 41 (82%) men and 9 (18%) women. Surgical management was equally divided between those who underwent total laryngectomy (n = 25) as primary treatment vs those who had salvage laryngectomy (n = 25) for persistent or recurrent disease. Prosthesis size was stable, with no change in diameter or length, in only 5 (10%) patients and unstable in 45 (90%), as they were changed at least once. The only factor that demonstrated statistical significance was sex (Fisher exact test = 0.035), with women being more likely to have a stable prosthesis size over time.ConclusionsThe results of this study demonstrate that 90% of patients who underwent total laryngectomy and tracheoesophageal puncture required a change in their prosthesis size beyond the first 3 months of expected healing. These results support the need for continual reassessment of the fistula tract when changing the prosthesis to ensure appropriate fit.
Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK
Authors: Gardiner Clare , Gott Merryn , Ingleton Christine , Seymour Jane , Cobb Mark , Noble Bill , Bennett Mike , Ryan Tony 
Published: May 2012

Background: In common with international health policy, The End of Life Care Strategy for England has highlighted the delivery of high quality palliative care in the acute hospital setting as an area of priority. Aim: The aim of this study was to explore the extent of palliative care need in the acute hospital setting, and to explore agreement between different sources in the identification of patients with palliative care need. Design: A cross-sectional survey of palliative care need was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Medical and nursing staff were asked to identify patients with palliative care needs. Patients (or consultees) completed assessments of palliative care need. Participants: Of a total in-patient population of 1359, complete datasets were collected for 514 patients/consultees. Results: 36.0% of patients were identified as having palliative care needs according to GSF criteria. Medical staff identified 15.5% of patients as having palliative care needs, and nursing staff 17.4% of patients. Patient self-report data indicated that 83.2% of patients meeting GSF criteria had palliative care needs. Conclusion: The results reveal that according to the GSF prognostic guide, over a third of hospital in-patients meet the criteria for palliative care need. Consensus between medical staff, nursing staff and the GSF was poor regarding the identification of patients with palliative care needs. This has significant implications for patient care, and draws into question the utility of the GSF in the hospital setting.
Neoliberalism and Ethnic Conflict
Authors: Prasch Robert E. 
Published: May 2012

In 1989 it was triumphantly announced that the world had arrived at the “End of History” with neoliberal economics and political democracy the clear victors. This paper revisits and reconsiders this famous assertion through an examination of several perspectives on the relationship between neoliberal economic policies and ethnic conflict. It concludes that these phenomena may be causally related, with the former contributing materially to the latter. JEL Codes: N40, O10, P16
Homo Economicus and the Economics of Property Rights
Authors: Milonakis Dimitris , Meramveliotakis Giorgos 
Published: May 2012

This article challenges some fundamental propositions of property rights theory by revealing the inability of new institutional economics to fully grasp the notion of property, as reflected in its narrow and problematic definition of property rights. The concept of property relations is proposed as better suited to capture the social and institutional aspects of property. By reconsidering the case of the Montagnais, originally used by Alchian and Demsetz for illustrative purposes, and drawing on the works of Polanyi and McManus, we show that the historical explanation of the emergence of (private) property rights provided by Alchian and Demsetz is flawed. JEL Codes: D02, D23, P14
Measuring functional outcome after total hip replacement with subject-specific hip joint loading
Authors: Weber Tim , Dendorfer Sebastian , Dullien Silvia , Grifka Joachim , Verkerke Gijsbertus Jacob , Renkawitz Tobias 
Published: May 2012

Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to determine whether or not it is feasible to compute the vectorial hip reaction force pathways on the head of the prosthesis and the force angles relative to the cup of the prosthesis that occur during gait in total hip replacement patients, serving as an objective measurement of the functional outcome following hip replacement. A three-dimensional gait analysis, measuring ground reaction forces and kinematics, was performed. The data retrieved from the gait analysis was used as the input for the musculoskeletal model to compute vectorial joint reaction forces for data processing. To evaluate the position and orientation of the joint reaction forces, the force path, as well as the force angles for the operated and non-operated joint, has been calculated during the stance phase of the specific leg. The force path for subject 2 on the non-operated side is only located in the posterior-lateral quarter, as is the force path for subject 1. In contrast to this subject, the force path for subject 2 at the operated hip joint can be found only within the anterior quarter of the head of the implant, where it is nearly equally distributed in the medio-lateral half of the prosthesis head. The force-inclination angles on the cup of subject 1, with respect to the plane of the socket face, indicates that the force vector is mainly positioned in the same quadrant when compared with subject 2 (in a cup-fixed coordinate system). The force-anteversion angle behaves similarly to the force-inclination angle, even when the effects are not as pronounced. The proposed methods in this article are aiming to define two functional outcomes of total hip replacement that are related to wear and rim loading. It is accepted that wear is not only a function of time, but a function of use. Owing to the methods listed in this article, we are able to determine a) the applied force and b) the sliding distance (force pathway) in a subject-specific manner. The computed hip-reaction force angles and the distance to the rim cup are a measurement for cup or rim loading, and occurs in the so-called safe-zones. This method may well give us insight into the biomechanical situation during gait, after receiving total hip replacement, that we need to fully understand the mechanisms acting on a hip joint and to prove a possible increase of functional outcome after receiving total hip replacement.
Antiphospholipid syndrome in northwest Italy (APS Piedmont Cohort): demographic features, risk factors, clinical and laboratory profile
Authors: Bertero MT , Bazzan M , Carignola R , Montaruli B , Silvestro E , Sciascia S , Vaccarino A , Baldovino S , Roccatello D 
Published: May 2012

We report the experience from the Antiphospholipid Antibodies (aPL) Regional Consortium in northwest Italy, meant to support clinical research and foster collaboration among health professionals regarding the diagnosis and management of antiphospholipid syndrome (APS) patients. This cohort-study (APS Piedmont Cohort) was designed to register the clinical characteristics at inception and associated immunological manifestations at diagnosis (if any) of patients who strictly fulfilled the current criteria for APS, all recruited at the Piedmont and Valle d'Aosta regions. Clinical and laboratory data from 217 APS patients (171 with vascular events, 33 with pregnancy morbidity and 13 with both), from 16 centres within the geographical area were collected. Venous thrombosis was recorded in 45.6% of patients, arterial thrombosis in 35%, small-vessel thrombosis in 1.12% and mixed arterial and venous thrombosis in the remaining 19.4% of the cases. Pregnancy morbidity included 19 patients with unexplained fetal death beyond the 10th week of pregnancy, 17 with premature birth before the 34th week and 10 with three or more unexplained spontaneous abortions before the 10th week of gestation. This consortium represents an instrument by which to audit clinical practice, to provide counselling to local centres and to sustain future basic and clinical APS research.
Sox4 cooperates with CREB in myeloid transformation
Authors: Sandoval Salemiz , Kraus Christina , Cho Er-Chieh , Cho Michelle , Bies Juraj , Manara Elena , Accordi Benedetta , Landaw Elliot M. , Wolff Linda , Pigazzi Martina , Sakamoto Kathleen M. 
Published: May 2012

Abstract
The cAMP response element-binding protein (CREB) is a nuclear transcription factor that is critical for normal and neoplastic hematopoiesis. Previous studies have demonstrated that CREB is a proto-oncogene whose overexpression promotes cellular proliferation in hematopoietic cells. Transgenic mice that overexpress CREB in myeloid cells develop a myeloproliferative disease with splenomegaly and aberrant myelopoiesis. However, CREB overexpressing mice do not spontaneously develop acute myeloid leukemia. In this study, we used retroviral insertional mutagenesis to identify genes that accelerate leukemia in CREB transgenic mice. Our mutagenesis screen identified several integration sites, including oncogenes Gfi1, Myb, and Ras. The Sox4 transcription factor was identified by our screen as a gene that cooperates with CREB in myeloid leukemogenesis. We show that the transduction of CREB transgenic mouse bone marrow cells with a Sox4 retrovirus increases survival and self-renewal of cells in vitro. Furthermore, leukemic blasts from the majority of acute myeloid leukemia patients have higher CREB, phosphorylated CREB, and Sox 4 protein expression. Sox4 transduction of mouse bone marrow cells results in increased expression of CREB target genes. We also demonstrate that CREB is a direct target of Sox4 by chromatin immunoprecipitation assays. These results indicate that Sox4 and CREB cooperate and contribute to increased proliferation of hematopoietic progenitor cells.
Distinct roles for long-term hematopoietic stem cells and erythroid precursor cells in a murine model of Jak2V617F-mediated polycythemia vera
Authors: Mullally Ann , Poveromo Luke , Schneider Rebekka K. , Al-Shahrour Fatima , Lane Steven W. , Ebert Benjamin L. 
Published: May 2012

Abstract
In the current model of the pathogenesis of polycythemia vera (PV), the JAK2V617F mutation arises in hematopoietic stem cells (HSCs) that maintain the disease, while erythroid precursor populations expand, resulting in excessive red blood cell production. We examined the role of these specific cell populations using a conditional Jak2V617F knockin murine model. We demonstrate that the most immature long-term (LT) HSCs are solely responsible for initiating and maintaining the disease in vivo and that Jak2V617F mutant LT-HSCs dominate hematopoiesis over time. When we induced Jak2V617F expression in erythropoietin receptor expressing precursor cells, the mice developed elevated hematocrit, expanded erythroid precursors, and suppressed erythropoietin levels. However, the disease phenotype was significantly attenuated compared with mice expressing Jak2V617F in LT-HSCs. In addition to developing a PV phenotype, all mice transplanted with Jak2V617F LT-HSCs underwent myelofibrotic transformation over time. These findings recapitulate the development of post-PV myelofibrosis in human myeloproliferative neoplasms. In aggregate, these results demonstrate the distinct roles of LT-HSCs and erythroid precursors in the pathogenesis of PV.
PV-1 is recognized by the PAL-E antibody and forms complexes with NRP-1
Authors: Keuschnigg Johannes , Tvorogov Denis , Elima Kati , Salmi Marko , Alitalo Kari , Salminen Tiina , Jalkanen Sirpa 
Published: May 2012

Abstract
Pathologische anatomie leiden endothelium (PAL-E) antibody has been used for more than 20 years as a prototype marker for vascular endothelium. The elusive target of this antibody has been claimed to be plasmalemma vesicle-associated protein-1 (PV-1) and neuropilin-1 (NRP-1). Using immunofluorescence, we show that PAL-E, anti–PV-1, anti–NRP-1, and anti-CD31 antibodies show largely identical staining patterns in the vasculature of different tissues. However, PV-1–transfected cells only bind PAL-E and anti–PV-1 antibodies, whereas NRP-1 transfectants stain with anti–NRP-1 antibodies in flow cytometry. Using lysates from tissues and transfected cells, we further confirm that the molecule recognized by PAL-E and anti–PV-1 antibodies is not NRP-1 but PV-1. Nevertheless, coimmunoprecipitation studies unambiguously demonstrate that NRP-1 can form complexes with PV-1. This connects, for the first time, 2 molecules involved in leukocyte trafficking and angiogenesis, thereby opening interesting possibilities for future research in this field.
Transmaternal cell flow leads to antigen-experienced cord blood
Authors: Dierselhuis Miranda P. , Blokland Els C. , Pool Jos , Schrama Ellen , Scherjon Sicco A. , Goulmy Els 
Published: May 2012

Abstract
Umbilical cord blood (UCB) is used for HSCT. It is known that UCB can comprise Ag-specific T cells. Here we question whether solely transmaternal cell flow may immunize UCB. Twenty-three female UCB samples were collected from healthy mothers and analyzed for minor histocompatibility Ag HY-specific responses. Forty-two of 104 tetramerpos T-cell clones, isolated from 16 of 17 UCB samples, showed male-specific lysis in vitro. Male microchimerism was present in 6 of 12 UCB samples analyzed. In conclusion, female UCB comprises HY-specific cytotoxic T cells. The immunization is presumably caused by transmaternal cell flow of male microchimerism present in the mother. The presence of immune cells in UCB that are not directed against maternal foreign Ags is remarkable and may explain the reported clinical observation of improved HSCT outcome with younger sibling donors.