bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Relevance of Improved Microbleed Detection by Susceptibility-Weighted Magnetic Resonance Imaging
Authors: Goos Jeroen D.C. , van der Flier Wiesje M. , Knol Dirk L. , Pouwels Petra J.W. , Scheltens Philip , Barkhof Frederik , Wattjes Mike P. 
Published: May 2011

Background and Purpose—
Susceptibility-weighted imaging (SWI) has been shown to be more sensitive in detecting cerebral microbleeds (MBs) than is conventional T2*-weighted gradient-recalled echo imaging (GRE). However, the clinical relevance of this improved detection in terms of associations with clinical measures and risk factors is unclear. We sought to determine whether associations of MBs with clinical characteristics, risk factors, white-matter hyperintensities, and lacunes were different on GRE versus SWI in memory clinic patients.

Methods—
One hundred forty-one patients presenting at our memory clinic were included and underwent clinical evaluation and a magnetic resonance imaging protocol including both GRE and SWI. Images were analyzed for numbers and locations of MBs and white-matter hyperintensities. In a subset of patients, apolipoprotein E status was determined. Negative binomial regression was used to assess clinical and radiologic associations with MB number.

Results—

MB prevalence was 23% on GRE and 40% on SWI. A total of 219 and 284 MBs were detected on GRE and SWI, respectively. Within groups with MBs, the median MB count was 1 (range, 1 to 144) on GRE and 2 (range, 1 to 129) on SWI (
P
<0.001). The increase in the number of MBs on SWI was equally distributed among brain regions. Strengths of the associations with age, sex, white-matter hyperintensities, and presence of lacunes with higher MB numbers were comparable for GRE and SWI (all
P
<0.05); no differential independent associations were detected.

Conclusions—
SWI detected more MBs in more patients, irrespective of MB location. However, this enhanced detection had no improved clinical relevance in terms of associations with vascular risk factors or radiologic markers of small-vessel disease.
CT Angiographic Source Images Predict Outcome and Final Infarct Volume Better Than Noncontrast CT in Proximal Vascular Occlusions
Authors: Bhatia Rohit , Bal Simerpreet S. , Shobha Nandavar , Menon Bijoy K. , Tymchuk Sarah , Puetz Volker , Dzialowski Imanuel , Coutts Shelagh B. , Goyal Mayank , Barber Philip A. , Watson Tim , Smith Eric E. , Demchuk Andrew M. 
Published: May 2011

Background and Purpose—
Alberta Stroke Programme Early CT Score (ASPECTS) is widely used for assessment of early ischemic changes in acute stroke. We hypothesized that CT angiography source image (CTA-SI) ASPECTS correlates better with baseline National Institutes of Health Stroke Scale score, final ASPECTS and neurological outcomes when compared with noncontrast CT ASPECTS.

Methods—
We studied patients presenting with acute ischemic stroke and identified proximal arterial occlusions (internal carotid artery, middle cerebral artery M1, and proximal middle cerebral artery M2) from the Calgary CT Angiography database. CT scans were independently read by 3 observers for baseline noncontrast CT ASPECTS, CT angiography source image ASPECTS, and follow-up ASPECTS. Details of demographics and risk factors were noted. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome.

Results—

We identified 261 patients with proximal occlusions for analysis. We found a better correlation between CT angiography source image ASPECTS and follow-up ASPECTS (Spearman correlation coefficient
r
=0.65; 95% CI, 0.58 to 0.72;
P
<0.001) than between noncontrast CT ASPECTS and follow-up CT ASPECTS (
r
=0.46; 95% CI, 0.36 to 0.55;
P
<0.001). CT angiography source image ASPECTS correlated better with baseline National Institutes of Health Stroke Scale and 24-hour National Institutes of Health Stroke Scale when compared with noncontrast CT ASPECTS (
P
<0.001). In an adjusted model including both CT angiography source image ASPECTS and noncontrast CT ASPECTS, CT angiography source image ASPECTS was associated with good outcome (OR, 2.30; 95%, CI, 1.16 to 4.53), whereas noncontrast CT ASPECTS was not (OR, 1.54; 95% CI, 0.84 to 2.82). Among imaging parameters, CT angiography source image ASPECTS was the only independent predictor of good outcome (OR, 2.29; 95% CI, 1.16 to 4.53).

Conclusions—
CT angiography source image ASPECTS correlates better with baseline stroke severity, is a better predictor of final infarct extension, and independently predicts neurological outcome than noncontrast CT ASPECTS.
Elderly Women Regulate Brain Blood Flow Better Than Men Do
Authors: Deegan Brian M. , Sorond Farzaneh A. , Galica Andrew , Lipsitz Lewis A. , O'Laighin Gearoid , Serrador Jorge M. 
Published: May 2011

Background and Purpose—
Orthostatic intolerance and falls differ between sexes and change with age. However, it remains unclear what role cerebral autoregulation may play in this response. This study was designed to determine whether cerebral autoregulation, assessed using transcranial Doppler ultrasound, is more effective in elderly females than in males.

Methods—

We used transcranial Doppler ultrasound to evaluate cerebral autoregulation in 544 (236 male) subjects older than age 70 years recruited as part of the MOBILIZE Boston study. The MOBILIZE Boston study is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. We assessed CO
2
reactivity and transfer function gain, phase, and coherence during 5 minutes of quiet sitting and autoregulatory index during sit-to-stand tests.

Results—

Male subjects had significantly lower CO
2
reactivity (males, 1.10±0.03; females, 1.32±0.43 (cm/s)/%CO
2
;
P
<0.001) and autoregulatory indices (males, 4.41±2.44; female, 5.32±2.47;
P
<0.001), higher transfer function gain (males, 1.34±0.49; females, 1.19±0.43;
P
=0.002), and lower phase (males, 42.7±23.6; females, 49.4±24.9;
P
=0.002) in the autoregulatory band, implying less effective cerebral autoregulation. However, reduced autoregulation in males was not below the normal range, indicating autoregulation was intact but less effective.

Conclusions—
Female subjects were better able to maintain cerebral flow velocities during postural changes and demonstrated better cerebral autoregulation. The mechanisms of sex-based differences in autoregulation remain unclear but may partially explain the higher rates of orthostatic hypotension-related hospitalizations in elderly men.
The ABCs of Accurate Volumetric Measurement of Cerebral Hematoma
Authors: Divani Afshin A. , Majidi Shahram , Luo Xianghua , Souslian Fotis G. , Zhang Jie , Abosch Aviva , Tummala Ramachandra P. 
Published: May 2011

Background and Purpose—
Both initial hematoma volume and hematoma growth are independent predictors of clinical outcomes and mortality among intracerebral hemorrhage patients. The purpose of this study was to evaluate the accuracy of different computed tomography image acquisition protocols and hematoma volume measurement techniques.

Methods—
We used plastic and cadaveric phantoms to determine the accuracy of different volumetric measurement techniques. We performed both axial and spiral computed tomography scans with 0.75-, 1.5-, 3.0-, and 4.5-mm-thick transverse sections (with no gap). Different measurement techniques (planimetry, ABC/2, and 3D rendering) and different window width/level settings (I, 150/50 versus II, 587/−321) were used to assess generated errors in volumetric calculations.

Results—

Both axial and spiral computed tomography scans yielded similar percent errors for different slice thicknesses and different measurement techniques. Comparison of different measurement techniques revealed a significant difference in measurement error only from the ABC/2 method as compared with 3D-rendering measurements (
P
<0.0001). The overall measurement error according to the ABC/2 method was further increased by ≈8% for irregularly shaped hematomas (
P
=0.0004). A significant percent difference in measurement error was observed between window width/levels I and II for both planimetry (mean difference across all thicknesses, 1.91±3.78,
P
=0.004) and Analyze software (mean difference across all thicknesses, 6.92±7.29,
P
<0.0001) methods.

Conclusions—
A better understanding of the limitations that may affect measurement of hematoma volume is crucial in the assessment of hematoma volume, which is considered an independent marker of clinical outcome.
Outcome Measurement in Stroke
Authors: Baker Karen , Cano Stefan J. , Playford E. Diane 
Published: May 2011

Background and Purpose—
Evaluating the impact of new treatments requires the use of reliable, valid, and responsive outcome measures. However, given the wide range of instruments currently available, it is not always straightforward for healthcare professionals to select the most appropriate tool. In this review, we propose a potential approach to scale selection.

Methods—
In designing a new study of the impact of a robotic device in stroke rehabilitation, we developed a three-stage scale selection strategy. First, two guidance documents (Medical Outcome Trust and Food and Drug Administration PRO Guidance) were reviewed to identify key scale assessment criteria. Second, consideration was given at a theoretical level of the concepts and domains relevant to the goals our study. Third, a comprehensive literature search strategy and review were developed in conjunction with healthcare professionals and psychometricians. Identified scales were appraised regarding their psychometric properties and clinical content.

Results—
Forty-five measures were initially identified and appraised. From a clinical content perspective, none of the measures were considered to be sufficient on their own to capture all the important outcome domains in this study. However, 3 measures were identified that best met our review criteria: Stroke Rehabilitation Assessment of Movement, Chedoke Arm and Hand Inventory, and ABILHAND. After the final stage of scale appraisal, two further upper limb scales (Fugl-Meyer and Action Research Arm Test) were included based on clinical content and study design issues.

Conclusions—
Our three-stage review process appears to be a potentially useful approach for evidence-based scale selection in stroke rehabilitation studies.
Partial Aortic Occlusion for Cerebral Perfusion Augmentation
Authors: Shuaib Ashfaq , Bornstein Natan M. , Diener Hans-Christoph , Dillon William , Fisher Marc , Hammer Maxim D. , Molina Carlos A. , Rutledge J. Neal , Saver Jeffrey L. , Schellinger Peter D. , Shownkeen Harish 
Published: May 2011

Background and Purpose—
Fewer than 5% of patients with acute ischemic stroke are currently treated, and there is need for additional treatment options. A novel catheter treatment (NeuroFlo) that increases cerebral blood flow was tested to 14 hours.

Methods—
The Safety and Efficacy of NeuroFlo in Acute Ischemic Stroke trial is a randomized trial of the safety and efficacy of NeuroFlo treatment in improving neurological outcome versus standard medical management. The primary safety end point was the incidence of serious adverse events through 90 days. The primary efficacy end point on a modified intent-to-treat population was a global disability end point at 90 days. Secondary end points included mortality, intracranial hemorrhage, modified Rankin scale score outcome of 0 to 2, and modified Rankin scale shift analysis.

Results—

Between October 2005 and January 2010, 515 patients were enrolled at 68 centers in 9 countries. The primary efficacy end point did not reach statistical significance (OR, 1.17; CI, 0.81–1.67;
P
=0.407). The primary safety end point did not show a difference in serious adverse events (
P
=0.923). Ninety-day mortality was 11.3% (26/230) in treatment and 16.3% (42/257) in control (
P
=0.087). Post hoc analyses showed that patients presenting within 5 hours (OR, 3.33; CI, 1.31–8.48), with NIHSS score 8 to 14 (OR, 1.80; CI, 0.99–3.30), or older than age 70 years (OR, 2.02; CI, 1.02–4.03) had better modified Rankin scale score outcomes of 0 to 2; additionally, there were fewer stroke-related deaths in treatment compared to control groups (7.4%=17/230; 14.4%=37/257).

Conclusions—
The trial met its primary safety end point but not its primary efficacy end point. Signals of treatment effect were suggested on all-cause mortality, in patients presenting early, older than age 70 years, or with moderate strokes, but these require confirmation.

Clinical Trial Registration Information—

URL:
http://clinicaltrials.gov
. Unique identifier: NCT00119717.
The Influence of Context on Hemispheric Recruitment during Metaphor Processing
Authors: Diaz Michele T. , Hogstrom Larson J. 
Published: May 2011

Abstract
Although the left hemisphere's prominence in language is well established, less emphasis has been placed on possible roles for the right hemisphere. Behavioral, patient, and neuroimaging research suggests that the right hemisphere may be involved in processing figurative language. Additionally, research has demonstrated that context can modify language processes and facilitate comprehension. Here we investigated how figurativeness and context influenced brain activation, with a specific interest in right hemisphere function. Previous work in our laboratory indicated that novel stimuli engaged right inferior frontal gyrus (IFG) and that both novel and familiar metaphors engaged right IFG and right temporal pole. The graded salience hypothesis proposes that context may lessen integration demands, increase the salience of metaphors, and thereby reduce right hemisphere recruitment for metaphors. In the present study, fMRI was used to investigate brain function, whereas participants read literal and metaphoric sentences that were preceded by either a congruent or an incongruent literal sentence. Consistent with prior research, all sentences engaged traditional left hemisphere regions. Differences between metaphors and literal sentences were observed, but only in the left hemisphere. In contrast, a main effect of congruence was found in the right IFG, the right temporal pole, and the dorsal medial pFC. Partially consistent with the graded salience hypothesis, our results highlight the strong influence of context on language, demonstrate the importance of the right hemisphere in discourse, and suggest that, in a wider discourse context, congruence has a greater influence on right hemisphere recruitment than figurativeness.
Updating Existing Emotional Memories Involves the Frontopolar/Orbito-frontal Cortex in Ways that Acquiring New Emotional Memories Does Not
Authors: Sakaki Michiko , Niki Kazuhisa , Mather Mara 
Published: May 2011

AbstractIn life, we must often learn new associations to people, places, or things we already know. The current fMRI study investigated the neural mechanisms underlying emotional memory updating. Nineteen participants first viewed negative and neutral pictures and learned associations between those pictures and other neutral stimuli, such as neutral objects and encoding tasks. This initial learning phase was followed by a memory updating phase, during which participants learned picture-location associations for old pictures (i.e., pictures previously associated with other neutral stimuli) and new pictures (i.e., pictures not seen in the first phase). There was greater frontopolar/orbito-frontal (OFC) activity when people learned picture–location associations for old negative pictures than for new negative pictures, but frontopolar OFC activity did not significantly differ during learning locations of old versus new neutral pictures. In addition, frontopolar activity was more negatively correlated with the amygdala when participants learned picture–location associations for old negative pictures than for new negative or old neutral pictures. Past studies revealed that the frontopolar OFC allows for updating the affective values of stimuli in reversal learning or extinction of conditioning [e.g., Izquierdo, A., & Murray, E. A. Opposing effects of amygdala and orbital PFC lesions on the extinction of instrumental responding in macaque monkeys. European Journal of Neuroscience, 22, 2341–2346, 2005]; our findings suggest that it plays a more general role in updating associations to emotional stimuli.
Auditory Short-term Memory Capacity Correlates with Gray Matter Density in the Left Posterior STS in Cognitively Normal and Dyslexic Adults
Authors: Richardson Fiona M. , Ramsden Sue , Ellis Caroline , Burnett Stephanie , Megnin Odette , Catmur Caroline , Schofield Tom M. , Leff Alex P. , Price Cathy J. 
Published: May 2011

Abstract
A central feature of auditory STM is its item-limited processing capacity. We investigated whether auditory STM capacity correlated with regional gray and white matter in the structural MRI images from 74 healthy adults, 40 of whom had a prior diagnosis of developmental dyslexia whereas 34 had no history of any cognitive impairment. Using whole-brain statistics, we identified a region in the left posterior STS where gray matter density was positively correlated with forward digit span, backward digit span, and performance on a “spoonerisms” task that required both auditory STM and phoneme manipulation. Across tasks and participant groups, the correlation was highly significant even when variance related to reading and auditory nonword repetition was factored out. Although the dyslexics had poorer phonological skills, the effect of auditory STM capacity in the left STS was the same as in the cognitively normal group. We also illustrate that the anatomical location of this effect is in proximity to a lesion site recently associated with reduced auditory STM capacity in patients with stroke damage. This result, therefore, indicates that gray matter density in the posterior STS predicts auditory STM capacity in the healthy and damaged brain. In conclusion, we suggest that our present findings are consistent with the view that there is an overlap between the mechanisms that support language processing and auditory STM.
Right Ventrolateral Prefrontal Cortex Mediates Individual Differences in Conflict-driven Cognitive Control
Authors: Egner Tobias 
Published: May 2011

Abstract
Conflict adaptation—a conflict-triggered improvement in the resolution of conflicting stimulus or response representations—has become a widely used probe of cognitive control processes in both healthy and clinical populations. Previous fMRI studies have localized activation foci associated with conflict resolution to dorsolateral PFC (dlPFC). The traditional group analysis approach employed in these studies highlights regions that are, on average, activated during conflict resolution, but does not necessarily reveal areas mediating individual differences in conflict resolution, because between-subject variance is treated as noise. Here, we employed a complementary approach to elucidate the neural bases of variability in the proficiency of conflict-driven cognitive control. We analyzed two independent fMRI data sets of face–word Stroop tasks by using individual variability in the behavioral expression of conflict adaptation as the metric against which brain activation was regressed while controlling for individual differences in mean RT and Stroop interference. Across the two experiments, a replicable neural substrate of individual variation in conflict adaptation was found in ventrolateral PFC (vlPFC), specifically, in the right inferior frontal gyrus, pars orbitalis (BA 47). Unbiased regression estimates showed that variability in activity in this region accounted for ∼40% of the variance in behavioral expression of conflict adaptation across subjects, thus documenting a heretofore unsuspected key role for vlPFC in mediating conflict-driven adjustments in cognitive control. We speculate that vlPFC plays a primary role in conflict control that is supplemented by dlPFC recruitment under conditions of suboptimal performance.
Overlapping Parietal Activity in Memory and Perception: Evidence for the Attention to Memory Model
Authors: Cabeza Roberto , Mazuz Yonatan S. , Stokes Jared , Kragel James E. , Woldorff Marty G. , Ciaramelli Elisa , Olson Ingrid R. , Moscovitch Morris 
Published: May 2011

Abstract
The specific role of different parietal regions to episodic retrieval is a topic of intense debate. According to the Attention to Memory (AtoM) model, dorsal parietal cortex (DPC) mediates top–down attention processes guided by retrieval goals, whereas ventral parietal cortex (VPC) mediates bottom–up attention processes captured by the retrieval output or the retrieval cue. This model also hypothesizes that the attentional functions of DPC and VPC are similar for memory and perception. To investigate this last hypothesis, we scanned participants with event-related fMRI whereas they performed memory and perception tasks, each comprising an orienting phase (top–down attention) and a detection phase (bottom–up attention). The study yielded two main findings. First, consistent with the AtoM model, orienting-related activity for memory and perception overlapped in DPC, whereas detection-related activity for memory and perception overlapped in VPC. The DPC overlap was greater in the left intraparietal sulcus, and the VPC overlap in the left TPJ. Around overlapping areas, there were differences in the spatial distribution of memory and perception activations, which were consistent with trends reported in the literature. Second, both DPC and VPC showed stronger connectivity with medial-temporal lobe during the memory task and with visual cortex during the perception task. These findings suggest that, during memory tasks, some parietal regions mediate similar attentional control processes to those involved in perception tasks (orienting in DPC vs. detection in VPC), although on different types of information (mnemonic vs. sensory).
Factors that facilitate and barriers towards the implementation of health educational programmes in primary education schools of the prefecture of Achaia, Greece
Authors: Cholevas Nikolaos K , Loucaides Constantinos A 
Published: May 2011

Aim: The purpose of this study was to explore the factors that facilitate and barriers towards the implementation of health education programmes in primary education schools of the prefecture of Achaia, Greece. Methods: The sample of the study included 141 educators from a total population of 218 educators who dealt with the implementation of health education programmes in Achaia prefecture during the school period of 2009–2010. The survey method was used to collect data by means of an anonymous questionnaire. Furthermore, at the beginning of the research process a semi-structured interview was carried out with four teachers to help in the development of the questionnaire items. Two factor analyses were conducted: one for the factors that facilitate and one for the barriers towards the implementation of health education programmes. Results: Findings indicated that the most significant factor that facilitates the implementation of innovative health education programmes is ‘Knowledge and skills of the Health Education Officer and the teachers’, which refers to the scientific knowledge, organizational skills, initiatives and the communicative skills of the Health Education Officer as well as to the teachers’ autonomy to select appropriate teaching methods and educational materials. On the other hand, the most important barrier in implementing health education programmes is ‘Limited experience and attitudes of teachers’, which refers to limited teaching experience in health education issues, as well as to professional burnout and the negative attitudes towards these innovative programmes. Conclusions: The Health Education Officer plays an important role in programme coordination by supporting, counselling, giving feedback and providing training/educational materials to teachers.