bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients Living in Impoverished Areas Have More Severe Ischemic Strokes
Authors: Kleindorfer Dawn , Lindsell Christopher , Alwell Kathleen A. , Moomaw Charles J. , Woo Daniel , Flaherty Matthew L. , Khatri Pooja , Adeoye Opeolu , Ferioli Simona , Kissela Brett M. 
Published: July 2012

Background and Purpose—
Initial stroke severity is one of the strongest predictors of eventual stroke outcome. However, predictors of initial stroke severity have not been well-described within a population. We hypothesized that poorer patients would have a higher initial stroke severity on presentation to medical attention.

Methods—
We identified all cases of hospital-ascertained ischemic stroke occurring in 2005 within a biracial population of 1.3 million. “Community” socioecomic status was determined for each patient based on the percentage below poverty in the census tract in which the patient resided. Linear regression was used to model the effect of socioeconomic status on stroke severity. Models were adjusted for race, gender, age, prestroke disability, and history of medical comorbidities.

Results—

There were 1895 ischemic stroke events detected in 2005 included in this analysis; 22% were black, 52% were female, and the mean age was 71 years (range, 19–104). The median National Institutes of Health Stroke Scale was 3 (range, 0–40). The poorest community socioeconomic status was associated with a significantly increased initial National Institutes of Health Stroke Scale by 1.5 points (95% confidence interval, 0.5–2.6;
P
<0.001) compared with the richest category in the univariate analysis, which increased to 2.2 points after adjustment for demographics and comorbidities.

Conclusions—
We found that increasing community poverty was associated with worse stroke severity at presentation, independent of other known factors associated with stroke outcomes. Socioeconomic status may impact stroke severity via medication compliance, access to care, and cultural factors, or may be a proxy measure for undiagnosed disease states.
Intra-Arterial Bone Marrow Mononuclear Cells in Ischemic Stroke
Authors: Moniche Francisco , Gonzalez Alejandro , Gonzalez-Marcos Jose-Ramon , Carmona Magdalena , Piñero Pilar , Espigado Ildefonso , Garcia-Solis David , Cayuela Aurelio , Montaner Joan , Boada Cristina , Rosell Anna , Jimenez Maria-Dolores , Mayol Antonio , Gil-Peralta Alberto 
Published: July 2012

Background and Purpose—
Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke. We aimed to assess the safety, feasibility, and biological effects of autologous BM-MNC transplantation in patients with stroke.

Methods—
A single-blind (outcomes assessor) controlled Phase I/II trial was conducted in patients with middle cerebral artery stroke. Autologous BM-MNCs were injected intra-arterially between 5 and 9 days after stroke. Follow-up was done for up to 6 months and blood samples were collected for biological markers. The primary outcome was safety and feasibility of the procedure. The secondary outcome was improvement in neurological function.

Results—

Ten cases (BM-MNC-treated) and 10 control subjects (BM-MNC-nontreated) were consecutively included. Mean National Institutes of Health Stroke Scale before the procedure was 15.6. Mean BM-MNCs injected were 1.59×10
8
. There was no death, stroke recurrence, or tumor formation during follow-up, although 2 cases had an isolate partial seizure at 3 months. After transplantation, higher plasma levels of beta nerve growth factor (β-nerve growth factor) were found compared with control subjects (
P
=0.02). There were no significant differences in neurological function at 180 days. A trend to positive correlation between number of CD34+ cells injected and Barthel Index was found (
r
=0.56,
P
=0.09).

Conclusions—
Intra-arterial BM-MNC transplantation in subacute ischemic stroke is feasible and seems to be safe. Larger randomized trials are needed to confirm the safety and elucidate the efficacy of BM-MNC transplantation.

Clinical Trial Registration-URL—

www.clinicaltrials.gov
. Unique identifier: NCT00761982.
Physical Therapists' Guideline Adherence on Early Mobilization and Intensity of Practice at Dutch Acute Stroke Units
Authors: Otterman Nicoline M. , van der Wees Philip J. , Bernhardt Julie , Kwakkel Gert 
Published: July 2012

Background and Purpose—
Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early mobilization and augmented exercise therapy time; and (3) identify the perceived barriers to and facilitators for guideline adherence as reported by physical therapists (PTs) working on acute hospital stroke units.

Methods—
All 96 Dutch acute hospital stroke units were requested to assign one PT for participation in the survey.

Results—
Of the 96 contacted PTs, 91 returned the questionnaire. Seventy-one percent of acute hospital stroke units reported that out-of-bed mobilization of patients was performed within 24 hours. PTs provided a mean of 22 minutes of physical therapy per weekday and weekend therapy was not standard practice. PTs reported having sufficient knowledge of and experience with the clinical practice guidelines for patients with stroke and reported that the clinical practice guidelines for patients with stroke left enough room for them to draw their own conclusions and to take patient preferences into account. PTs perceived insufficient time to comply with the clinical practice guidelines for patients with stroke and a need for financial compensation to realize human resources.

Conclusions—
Our national survey among PTs suggests that the organization of early stroke rehabilitation varies considerably and that early mobilization and intensity of practice in early stroke rehabilitation are not optimal. Addressing this problem requires agreement between hospital management boards and insurance companies about minimum services and resources required and the introduction of novel methods of increasing duration of exercise therapy with minimal use of resources.
Isoflurane Attenuates Blood–Brain Barrier Disruption in Ipsilateral Hemisphere After Subarachnoid Hemorrhage in Mice
Authors: Altay Orhan , Suzuki Hidenori , Hasegawa Yu , Caner Basak , Krafft Paul R. , Fujii Mutsumi , Tang Jiping , Zhang John H. 
Published: July 2012

Background and Purpose—
We examined effects of isoflurane, volatile anesthetics, on blood–brain barrier disruption in the endovascular perforation model of subarachnoid hemorrhage (SAH) in mice.

Methods—
Animals were assigned to sham-operated, SAH+vehicle–air, SAH+1%, or 2% isoflurane groups. Neurobehavioral function, brain water content, Evans blue dye extravasation, and Western blotting for sphingosine kinases, occludin, claudin-5, junctional adhesion molecule, and vascular endothelial cadherin were evaluated at 24 hours post-SAH. Effects of sphingosine kinase (N,N-dimethylsphingosine) or sphingosine-1-phosphate receptor-1/3 (S1P1/3) inhibitors (VPC23019) on isoflurane's action were also examined.

Results—
SAH aggravated neurological scores, brain edema, and blood–brain barrier permeability, which were prevented by 2% but not 1% isoflurane posttreatment. Two percent isoflurane increased sphingosine kinase-1 expression and prevented a post-SAH decrease in expressions of the blood–brain barrier-related proteins. Both N,N-dimethylsphingosine and VPC23019 abolished the beneficial effects of isoflurane.

Conclusions—
Two percent isoflurane can suppress post-SAH blood–brain barrier disruption, which may be mediated by sphingosine kinase 1 expression and sphingosine-1-phosphate receptor-1/3 activation.
Warfarin-Associated Intracerebral Hemorrhage Is Inadequately Treated at Community Emergency Departments
Authors: Liotta Eric M. , Garg Rajeev K. , Temes Richard E. , John Sayona , Lee Vivien H. , Bleck Thomas P. , Prabhakaran Shyam 
Published: July 2012

Background and Purpose—
The purpose of this study was to investigate time delays, adherence to guidelines, and their impact on outcomes in patients with warfarin-associated intracerebral hemorrhage transferred from community emergency departments to a comprehensive stroke center.

Methods—
We collected demographic, clinical, transfer time, treatment, and outcome data for patients transferred to our institution with warfarin-associated intracerebral hemorrhage from community emergency departments.

Results—
Among 928 patients with intracerebral hemorrhage, 56 (6%) with warfarin-associated intracerebral hemorrhage (median international normalized ratio, 2.55) were transferred to the comprehensive stroke center. Twenty patients received no acute reversal therapy before transfer, only 4 of whom had international normalized ratios ≤1.4 in the community emergency department. Median time of emergency department stay was 3.66 hours and median time to initiation of acute reversal therapy was 4.48 hours. Those who received ≥3 U of fresh–frozen plasma or recombinant activated Factor VIIa (11 patients) before transfer had lower repeat international normalized ratios and better discharge dispositions than those treated less aggressively.

Conclusions—
Treatment of warfarin-associated intracerebral hemorrhage in community emergency departments is often suboptimal and does not adhere to published guidelines. Treating coagulopathy aggressively before interhospital transfer may improve outcomes and warrants further investigation.
Team Communication During Patient Handover From the Operating Room
Authors: Manser Tanja , Foster Simon , Flin Rhona , Patey Rona 
Published: July 2012

Objective: This study was aimed at examining team communication during postoperative handover and its relationship to clinicians’ self-ratings of handover quality. Background: Adverse events can often be traced back to inadequate communication during patient handover. Research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. Method: We conducted a prospective, cross-sectional observation study using a taxonomy for handover behaviors developed on the basis of established approaches for analyzing teamwork in health care. Immediately after the observation, transferring and receiving clinicians rated the quality of the handover using a structured tool for handover quality assessment. Handover communication during 117 handovers in three postoperative settings and its relationship to clinicians’ self-ratings of handover quality were analyzed with the use of correlation analyses and analyses of variance. Results: We identified significantly different patterns of handover communication between clinical settings and across handover roles. Assessments provided during handover were related to higher ratings of handover quality overall and to all four dimensions of handover quality identified in this study. If assessment was lacking, we observed compensatory information seeking by the receiving team. Conclusion: Handover quality is more than the correct, complete transmission of patient information. Assessments, including predictions or anticipated problems, are critical to the quality of postoperative handover. Application: The identification of communication behaviors related to high-quality handovers is necessary to effectively support the design and evaluation of handover improvement efforts.
Apoptosis and lipid peroxidation in ochratoxin A- and citrinin-induced nephrotoxicity in rabbits
Authors: Kumar Manoj , Dwivedi Prabhaker , Sharma Anil Kumar , Sankar Muthu , Patil Rajendra Damu , Singh Nittin Dev 
Published: July 2012

Ochratoxin A (OTA) and citrinin (CIT) are nephrotoxic mycotoxins produced mainly by fungal species Aspergillus ochraceus and Penicillium citrinum, respectively, which have been found to occur together in various food and feed commodities. In the present study, both OTA and CIT were evaluated for their potential to induce oxidative damage by determining lipid peroxidation (LPO) through malondialdehyde (MDA) assay and apoptosis by flow cytometry, gel electrophoresis and renal ultrastructural morphology in rabbits fed with diets containing OTA (0.75 mg/kg feed), CIT (15 mg/kg feed) and OTA + CIT (0.75 and 15 mg/kg feed, respectively) up to 60 days. The concentration of MDA was found significantly higher in OTA and combination-treated groups. OTA and combination-treated groups revealed more apoptotic cells in flow cytometry when compared with the CIT-treated group. Characteristic DNA fragmentation, as evidenced by ladder pattern in electrophoresis appeared in the toxin-treated groups. Ultrastructurally, interstitial cells showed nuclear fragmentation and cytoplasmic blebbing in OTA- and CIT-treated groups; whereas, proximal convoluted tubular epithelial cells, besides interstitial cells, showed nuclear fragmentation in the combined treatment group. The results suggested that low concentrations of OTA and CIT either alone or in combination induced apoptosis in a time-dependent manner and LPO in the rabbit kidney, which appeared to play a major role in the pathogenesis of nephrotoxicity. Furthermore, the interaction of these two nephrotoxic mycotoxins was found to be additive.
Effects of 99mTc sestamibi on antioxidant defense system and lipid peroxidation in the heart of Sprague Dawley rats
Authors: Cesur Gokhan , Doguc Duygu Kumbul , Yildiz Mustafa , Ogut Serdal , Polat Mumin , Ongel Kurtulus 
Published: July 2012

Nuclear medicine has been using radiopharmaceuticals for the diagnostic and therapeutic purposes of many diseases. Technetium-99m methoxyisobutylisonitrile (99mTc sestamibi) is a lypophilic complex that has a positive-loaded isonitril group. Aim of the study is to investigate whether 99mTc sestamibi, which is one of the mostly used radiopharmaceuticals in nuclear medicine field, causes oxidative damage or not in rats’ heart after an injection. A total of 16 male Sprague Dawley rats were randomly divided into two groups: group I: 99mTc sestamibi group, 99mTc sestamibi administered intravenously with the dose of 25MBq; group II: control group, one dose of isotonic sodium chloride was administered intravenous with the same volume as 99mTc sestamibi group. Malondialdehyde (MDA) and total oxidant status (TOS) were used as markers of oxidative stress-induced heart impairment. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and total antioxidant status (TAS) activities were studied to evaluate the changes in the antioxidant status. In the 99mTc sestamibi group (group I), animals treated with 99mTc sestamibi produced a significant decrease in the activities of antioxidant enzymes (SOD and CAT), while MDA level increased when compared with control group (group II) in myocardial tissue ( p < 0.05). On the other hand, the GSH-Px activities were significantly increased in the 99mTc sestamibi-treated rats compared with the untreated rats ( p < 0.05). There was no significant difference in the TAS and TOS levels of plasma.
Suicide is preventable, sometimes
Authors: Walter Garry , Pridmore Saxby 
Published: July 2012

Objective: The objective was to examine the assumption that suicide is inevitably preventable. Conclusions: Suicide may not always be avoidable. This does not mean that every effort should not be made to prevent it or vigorously treat illnesses that are often contributory. The assumption, however, may give rise to undue optimism, and unjustified blame when suicides do occur.
E-CYMHS: an expansion of a child and youth telepsychiatry model in Queensland
Authors: Wood Jennylee , Stathis Stephen , Smith Anthony , Krause Judi 
Published: July 2012

Objectives: The purpose of this study was to describe the evolution of the E-Child and Youth Mental Health Service (E-CYMHS), which supports regional and rural mental health services by providing access to consultant child and adolescent psychiatrists to isolated staff in regional areas, where access to specialist psychiatric services is limited. Conclusions: E-CYMHS provides a level of parity in mental health care between metropolitan, regional and remote services through the provision of regular videoconferencing services with child and adolescent psychiatrists and senior allied health clinicians. The three key features which underpin the success of the service are: 1. A central co-ordinator of services; 2. Provision of support outside regular videoconference times; and 3. Routine outreach visits that foster community capacity-building. E-CYMHS has been well received by the regional mental health services it supports, and the total provision of services has more than doubled over the last three years. It is anticipated that as telepsychiatry is increasingly viewed as a credible alternative to traditional means of patient care, this trend is likely to continue.
Interpersonal Touch
Authors: Papathanassoglou Elizabeth D. E. , Mpouzika Meropi D. A. 
Published: July 2012

Introduction: Nurses use several forms of touch in patient encounters. Interpersonal touch elicits specific physiological and psychological responses, including neuroendocrine effects and reduction of stress. Critical illness is a state of excessive physiological and psychological stress. Aims: To critically review evidence on the effect of touch on physiological outcomes in critically ill individuals. Results of intervention studies in adult critical care settings were reviewed along with supportive evidence from studies in other populations. Methods: Critical literature review based on studies published in MEDLINE, PubMed, Cinahl, Embase, and Cochrane databases. Results: Eleven studies were reviewed. Significant effects of interpersonal touch included lower systolic and diastolic blood pressure and respiratory rate, improved sleep, and decreased pain. Almost no results were replicated owing to discrepancies among studies. Although the effect of touch on cardiovascular autonomic status appears considerable, several confounders must be considered. In noncritically ill populations, replicable findings included increased urinary dopamine and serotonin, natural killer cytotoxic activity, and salivary chromogranin. Effects on plasma cortisol and immune cells were variable. Effects appear to vary according to amount of pressure, body site, duration, and timing: Moderate pressure touch may elicit a parasympathetic response in contrast to light touch, which may elicit a sympathetic response. Moreover, touch effects may be mediated by the density of autonomic innervation received by the body areas involved and repetition of sessions. Conclusion: The physiological pathway mediating the effects of touch is unclear. Although no concrete conclusions can be drawn, research evidence suggests that touch interventions may benefit critically ill individuals.
Predictors of driving in individuals with relapsing–remitting multiple sclerosis
Authors: Akinwuntan Abiodun Emmanuel , Devos Hannes , Stepleman Lara , Casillas Rhonda , Rahn Rebecca , Smith Suzanne , Williams Mitzi Joi 
Published: July 2012

Background: We previously reported that performance on the Stroke Driver Screening Assessment (SDSA), a battery of four cognitive tests that takes less than 30 min to administer, predicted the driving performance of participants with multiple sclerosis (MS) on a road test with 86% accuracy, 80% sensitivity, and 88% specificity. Objectives: In this study, we further investigated if the addition of driving-related physical and visual tests and other previously identified cognitive predictors, including performance on the Useful Field of View test, will result in a better accuracy of predicting participants’ on-road driving performance. Methods: Forty-four individuals with relapsing–remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the SDSA. The model that explained the highest variance of participants’ performance on a standardized road test was identified using multiple regression analysis. A discriminant equation containing the tests included in the best model was used to predict pass or fail performance on the test. Results: Performance on 12 cognitive and three visual tests were significantly associated with performance on the road test. Five of the tests together explained 59% of the variance and predicted the pass or fail outcome of the road test with 91% accuracy, 70% sensitivity, and 97% specificity. Conclusion: Participants’ on-road performance was more accurately predicted by the model identified in this study than using only performance on the SDSA test battery. The five psychometric/off-road tests should be used as a screening battery, after which a follow-up road test should be conducted to finally decide the fitness to drive of individuals with relapsing–remitting MS. Future studies are needed to confirm and validate the findings in this study.
Genetics of the renin-angiotensin system with respect to cardiac and blood pressure phenotypes in healthy newborn infants
Authors: Gorący Iwona , Dawid Grażyna , Łoniewska Beata , Gorący Jarosław , Ciechanowicz Andrzej 
Published: July 2012

Introduction: Left ventricular mass (LVM) is a strong predictor of various heart diseases. We examine the association between the G(-6)A AGT, I/D ACE, A1166C AGTR1, T(-344)C CYP 11β2, A538G MR and A10631G REN polymorphisms and LVM and blood pressure in newborn infants. Material and methods: The study included 211 healthy newborn infants. Two-dimensional M-mode echocardiography was used to assess LVM between days 3–4 after birth. Polymorphisms were determined by polymerase chain reaction - restriction fragment length polymorphism (PCR-RLFP). Results: AGTR1 genotype was significantly associated with neonatal systolic blood pressure (≥90 percentile). LVM indexes (LVMIs) were tested for association with genotypes in multivariate analysis. The carriers of the A allele of the AGT polymorphism had significantly higher LVM/body length (BL) values when compared with newborn infants homozygous for the G allele ( padjusted=0.03). The higher LVM/BL values were seen in the carriers of the A alleles of the AGTR1 polymorphism ( padjusted=0.046). All examined indexes (LVM/body surface area (BSA), LVM/BL, LVM/bodyweight (BW)) were associated with CYP11B polymorphism. The newborn infants homozygous for the T allele had significantly higher values of LVM/BSA, LVM/BL, and LVB/BW compared to non-TT-homozygous neonates ( padjusted=0.003; padjusted=0.003; padjusted=0.004 respectively). Conclusion: The AGT, AGTR1, CYP11β polymorphisms are associated with increased LVMIs in newborns. This observation indicates that genetic factors may be modulating LVM at birth.