1,721,132 research outputs found
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The cost of epilepsy care in referral centers in Italy.
No full textThe study evaluated the cost of diagnosis and treatment of epilepsy by prognostic group in referrals centers for epilepsy
Update of trends in mortality from stroke in Italy from 1955 to 1987
No full textMortality form stroke in Italy over the period 1955-1987 was analysed in terms of age-specific, age-standardised death certification rates, and by means of a log-linear model to separate the effects of age, cohort of birth and calendar period of death. In males the overall age-adjusted rate on the world standard population fell from 118.4/100,000 population in 1955-1959 to 72.0 in 1985-1987 and in females from 94.8 in 1955-1959 to 54.7 in 1985-1987. The overall decline in age-standardised rates over the 3 decades was thus 39% for males (averaging 1.7%/year) and 42% for females (averaging 1.9%/year). The declines were even greater in truncated rates from 35 to 64 years: from 80.4 to 41.2/100,000 for males (49%), and from 63.0 to 24.1/100,000 for females (62%). Inspection of age-specific rates shows comparable falls--in relative terms--in early and later middle age. For instance, male rates declined from 70.4 to 38.1/100,000 (46%) at age 50-54, and from 1,151.1 to 584.2/100,000 (50%) at age 70-74. Only above age 75 were the falls smaller. In females aged 50-54 years the decline was 63%, and for those aged 70-74 years it was 59%. In young adults, no appreciable changes were observed in either sex. Thus, the age, period and cohort model showed downwards trends in both the period and cohort effect, except for the most recent cohorts on account of an age-cohort interaction. These favourable trends are discussed in relation to better control of hypertension and the potential impact of other risk factors
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Direct cost of medical management of epilepsy among adults in Italy: a prospective cost-of-illness study (EPICOS)
No full textPurpose: To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories.
Methods: A 12-month prospective observational study was conducted in 15 epilepsy centers from Northern, Central, and Southern Italy. The study population included a random sample of individuals aged 18 years and older with newly diagnosed (ND) epilepsy, seizure remission (R), occasional seizures (OS), active non-drug-resistant (NDR) seizures, drug-resistant (DR) seizures, or surgical candidates (SC). Estimates of the direct costs of care of epilepsy were based on the use of diagnostic examinations, laboratory tests, specialist consultations, hospital admissions, day-hospital days, and drugs, taking the Italian National Health Service perspective.
Results: The sample included 631 patients (ND 62, R 158, OS 155, NDR 114, DR 128, and SC 14). The SC group had the highest total cost per patient (Euro3,619) followed by DR (Euro2,190), ND (Euro976), NDR (Euro894), OS (Euro830), and R (Euro561). For each epilepsy group, the main components of the total cost were drugs and hospital admissions. Drug costs increased from the R group to the DR group. The new antiepileptic drugs (AEDs) were the largest part of the cost of treatment.
Conclusions: The costs of epilepsy in referral patients vary significantly according to the time course of the disease and the response to treatment. Hospital admissions and drugs are the major sources of expenditure
Acceptance of epilepsy surgery among adults with epilepsy : What do patients think?
No full textPhysician inertia is usually blamed for the underutilization of epilepsy surgery (ES) at the cost of increased patient disability and risk of mortality. Investigations on selected groups of intractable TLE patients and minorities suggested that patient beliefs may also limit access to ES. To assess acceptance of ES among “mainstream” patients, we distributed an ad hoc questionnaire to 228 adults attending epilepsy clinics and found widespread fears and misconceptions leading to unfavorable perception of ES, irrespective of diagnosis, seizure type, and degree of intractability. Moreover, while a group firmly rejected ES, the majority became more favorable when given further information about modality, rationale, and expected outcome of ES. Attitude changes correlated with patient's social profile. Neurologists are responsible for providing all pertinent information to potential surgical candidates as soon as indicated. Therefore, an untimely or inadequate intervention of the treating physician constitutes an additional barrier to optimal utilization of ES
PROGNOSTIC SIGNIFICANCE OF SYNDROMIC CLASSIFICATION IN NEWLY DIAGNOSED EPILEPSY PATIENTS
No full textPurpose: To assess the frequency, timing, patterns and prognostic significance of change of the syndromic diagnosis in a cohort of newly diagnosed adults with epilepsy.Method: 180 newly diagnosed adults from an epilepsy centre were included and followed for 852.4 person years. For each patient, the syndromic diagnosis was made at entry according to simplified categories. Changes of the diagnostic categories were then recorded retrospectively during follow-up. A change of the syndromic diagnosis was made and dated, based on new data on seizure types and/or EEG findings and/or neuroimaging results. Using survival analysis, the cumulative time-dependent probability of change of syndromic category and of 2-year remission was measured. Differences were tested with the logrank test. A multivariate analysis was performed using Cox’s proportional hazard function. Results: The sample included 104 men and 80women aged 15 through 84 years. At entry, 61 patients (33.9%) had partial epilepsies, 42 (23.3%) had generalised epilepsies, 19 (10.6%) had undetermined epilepsies, and 58 (32.2%) had isolated seizures. The syndromic diagnosis was changed during follow-up in 54 cases (30%). The cumulative probability of change was 10% at six months, 16%, 19%, and 25% at 12, 24, and 36 months. 83% of changes were in patients with isolated seizures who relapsed (45 cases). A total of 105 patients (58.3%) achieved 2-year remission. The cumulative probability of remission was similar when comparing patients with and without change of the syndromic diagnosis (log-rank 0.11; p = ns), after excluding those with isolated seizures at entry, and when adjusting for age, sex, disease duration at entry, and treatment in the multivariate analysis model. Conclusion: Except for isolated seizures, the syndromic diagnosis at entry changed infrequently (mostly during the first year) in adults and did not affect the chance of long-term remission of epilepsy
Barriers toward epilepsy surgery. A survey among practicing neurologists
No full textPurpose: Guidelines for refractory epilepsy recommend timely referral of potential surgical candidates to an epilepsy center for evaluation. However, this approach is seldom a priority for treating neurologists, possibly because of inertia of previous practice and personal attitudes, leading to a buildup of psychosocial disabilities and increased risk of morbidity and mortality. The aim of this study was to assess knowledge and attitudes toward epilepsy surgery among practicing neurologists and identify the barriers that delay the treatment. Methods: We surveyed 183 Italian adult and child neurologists with an ad hoc questionnaire exploring physicians' willingness to refer patients for epilepsy surgery when such treatment may be indicated. Thirteen of 14 questions had graded answers ranging from 1 (unfavorable to surgery) to 10 (favorable). We compared the overall scores and per-question scores of the neurologists versus a group of academic and clinical leaders in the field. Key Findings: The neurologists gave responses characterized by extreme variability (i.e., wide response interquartile range) around intermediate scores. Experts had higher and less variable scores favoring surgery. The two groups differed significantly on issues such as how long to pursue pharmacologic treatment and information about indications and outcome of surgery. Multivariate analysis indicated that neurologists' attitudes correlated with the number of patients referred for surgery (p < 0.01) and the geographical region where specialty was attained (p < 0.01). Other variables such as years in practice, number of patients treated for epilepsy, or type of specialty had no predictive value on physicians' behavior. Significance: The majority of Italian neurologists have highly variable attitudes toward epilepsy surgery, reflecting ambivalence and uncertainty toward this type of treatment. About two thirds of responders are nonaligned with the opinion leaders, mainly due to differences in handling pharmacologic treatment and information regarding epilepsy surgery, which affect their attitudes and ultimately patient management. Strategies that may solve the lack of agreement include reinforcing the concept of pharmacoresistance and associated risks, as opposed to the safety and potential benefits of surgery, the use of epilepsy quality measures during follow-up, and the adoption of structured referral sheets and greater involvement of patients in decision making. These measures should facilitate the referral of potential candidates for surgical evaluation and improve overall quality of care
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