10 research outputs found
Table_1_Development of Cortical Lesion Volumes on Double Inversion Recovery MRI in Patients With Relapse-Onset Multiple Sclerosis.DOCX
No full textBackground and Objective: In multiple sclerosis (MS) patients, Double Inversion Recovery (DIR) magnetic resonance imaging (MRI) can be used to detect cortical lesions (CL). While the quantity and distribution of CLs seems to be associated with patients' disease course, literature lacks frequent assessments of CL volumes (CL-V) in this context. We investigated the reliability of DIR for the longitudinal assessment of CL-V development with frequent follow-up MRIs and examined the course of CL-V progressions in relation to white-matter lesions (WML), contrast enhancing lesions (CEL) and clinical parameters in patients with Relapsing-Remitting Multiple Sclerosis (RRMS).Methods: In this post-hoc analysis, image- and clinical data of a subset of 24 subjects that were part of a phase IIa clinical trial on the “Safety, Tolerability and Mechanisms of Action of Boswellic Acids in Multiple Sclerosis (SABA)” (ClinicalTrials.gov, NCT01450124) were included. The study was divided in three phases (screening, treatment, study-end). All patients received 12 MRI follow-up-examinations (including DIR) during a 16-months period. CL-Vs were assessed for each patient on each follow-up MRI separately by two experienced neuroradiologists. Results of neurological screening tests, as well as other MRI parameters (WML number and volume and CELs) were included from the SABA investigation data.Results: Inter-rater agreement regarding CL-V assessment over time was good-to-excellent (κ = 0.89). Mean intraobserver variability was 1.1%. In all patients, a total number of 218 CLs was found. Total CL-Vs of all patients increased during the 4 months of baseline screening followed by a continuous and significant decrease from month 5 until study-end (p Conclusion: DIR MRI seems to be a reliable tool for the frequent assessment of CL-Vs. Overall CL-Vs decreased during the follow-up period and were associated with improvements of cognitive and disability status scores. Our results suggest the presence of short-term CL-V dynamics in RRMS patients and we presume that the laborious evaluation of lesion volumes may be worthwhile for future investigations.Clinical Trial Numbers:www.ClinicalTrials.gov, “The SABA trial”; number: NCT01450124</p
Régimen Académico Docente de la Universidad de Costa Rica / Tenure track at the Universidad de Costa Rica
No full textEl Régimen Académico Docente de la Universidad de Costa Rica (UCR) es el sistema que le permite al profesorado universitario hacer carrera profesional docente y avanzar hacia diversas categorías con base en sus méritos académicos y en su experiencia universitaria. Las publicaciones, obras artísticas, didácticas o profesionales calificadas son el rubro más importante para aumentar el puntaje en el tiempo. Sin embargo, en el caso del profesorado en la categoría “catedrático”, se ha estudiado si variables como el tipo de nombramiento y la jornada laboral, distribuida entre tiempos de investigación y de docencia, influyen en la cantidad de las publicaciones realizadas. En ese sentido, la información utilizada en este trabajo fue tomada de los registros de la Comisión de Régimen Académico Docente, en el mes de marzo del 2011, en la Sección de Cargas Académicas del Centro de Evaluación Académica (CEA), Vicerrectoría de Docencia, durante el primer ciclo del 2011. Dicho estudio ha demostrado que, en efecto, variables como el tipo de nombramiento, la jornada que labora y el tiempo dedicado a las labores docentes sí influyen en la cantidad de publicaciones que puede realizar un profesor o profesora universitaria. Adicionalmente, la forma en que el reglamento de Régimen Académico valora y cuantifica los trabajos, según el número de autores por publicación, es de igual forma una variable muy importante, porque incide en el puntaje que puede obtener el profesorado. Por lo anterior, se sugiere la incorporación del Portafolio de Vida Docente para que todo el profesorado sea evaluado con un mismo criterio, ya que el cuerpo docente debe impartir la docencia. The tenure track at the UCR valorates scientific publications and art pieces to upgrade its professors in their academic career. However, there are certain contractual conditions that may determine the final score an academic can obtain. These conditions are the number of teaching hours per week; the type of contract and type of appointments and the criteria to assess professors' works. The information presented in this paper was taken from the records of the Vicepresidency of Academic Affairs at UCR. This work has determined that the type of contract, the amount of teaching hours per week and the way publications are assessed are important factors that have a direct impact in a Professor academic career and upgrades. Since teaching is a compulsory activity for academics at this university, but research has a heavier weight in Professors assessment, the author suggests the incorporation of the Academic Life Portfolio (Portafolio de Vida Docente) as a criteria for advancing in academic career so that teaching and pedagogy become as important mechanism as research in academic track and upgrades
Withdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study
No full textBackground: in the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. Methods: the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. Results: of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). Conclusions: WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. Clinical Trial Registration: the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079)
Withdrawal of active treatment after intracerebral haemorrhage in the INTERACT2 study
No full textBackground: in the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2), a minority of patients received withdrawal of active treatment (WAT). We wished to determine the characteristics of these patients, and the relation of this decision-making to subsequent management and final outcome. Methods: the INTERACT2 cohort of acute intracerebral haemorrhage (ICH) patients had a decision of WAT within 7 days after hospital admission recorded. Multivariable logistic regression was used to identify the determinants of WAT and poor outcome at 90 days, defined by modified Rankin scale (mRS) scores 3-6. Results: of 2,779 participants with available data, WAT occurred in 121 (4%) and this was significantly associated with increasing age, greater neurological severity, larger haematoma volume, intraventricular extension and randomisation to intensive BP lowering. Compared to other patients, those with WAT had greater mortality (81/121 [67%] versus 205/2624 [8%]; P < 0.001) and survivors were more likely to be severely disabled (mRS score 4-5, 19/39 [49%] versus 695/2419 [29%]; P = 0.006). Conclusions: WAT was undertaken in patients with recognised predictors of poor prognosis, who subsequently were more likely to die or be left with severe disability. Improved understanding of specific factors determining WAT in ICH patients might improve care delivery and outcomes. Clinical Trial Registration: the INTERACT2 study is registered with ClinicalTrials.gov (NCT00716079)
Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage.
No full textBACKGROUND: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. STUDY DESIGN: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP90, 60-90, and <60mL/min/1.73m(2), respectively). OUTCOMES: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. RESULTS: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P=0.5 for homogeneity). LIMITATIONS: Generalizability issues arising from a clinical trial population. CONCLUSIONS: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs
Supplementary Material for: Comparison of ABC Methods with Computerized Estimates of Intracerebral Hemorrhage Volume: The INTERACT2 Study
No full textBackground and Purpose: Hematoma volume is a key determinant of outcome in acute intracerebral hemorrhage (ICH). We aimed to compare estimates of ICH volume between simple (ABC/2, length, width, and height) and gold standard planimetric software approaches. Methods: Data are from the second Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Multivariable linear regression was used to compare ICH volumes on baseline CT scans using the ABC/2, modified ABC/2 (mABC/2), and MIStar software. Other aspects of ICH morphology examined included location, irregularity, heterogeneity, intraventricular and subarachnoid hemorrhage extension (SAH) of hematoma, and associated white matter lesions and brain atrophy. Results: In 2,084 patients with manual and semiautomated measurements, median (IQR) ICH volumes for each approach were: ABC/2 11.1 (5.11–20.88 mL), mABC/2 7.8 (3.88–14.11 mL), and MIStar 10.7 (5.59–18.66 mL). Median differences between ABC/2 and MIStar, and mABC/2 and MIStar were 0.34 (–1.01 to 2.96) and –2.4 (–4.95 to –0.7416), respectively. Hematoma volumes differed significantly with irregular shape (ABC/2 and MIStar, p p = 0.007) and larger volumes (mABC/2 and MIStar, p p = 0.07). ICH with SAH showed a significant discrepancy between ABC/2 and MIStar (p Conclusions: Overall, ABC/2 performs better than mABC/2 in estimating ICH volume. The largest discrepancies were evidenced against automated software for irregular-shaped and large ICH with SAH, but the clinical significance of this is uncertain
Intracerebral hemorrhage location and outcome among INTERACT2 participants
No full textOBJECTIVE: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS: Associations between ICH sites and poor outcomes (death [6] or major disability [3-5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models. RESULTS: Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively). CONCLUSION: Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule. CLINICALTRIALSGOV REGISTRATION: NCT00716079
Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage
No full textBackground: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.Peer reviewe
Life stories, social action and the Third Space: a biographical narrative interpretive study of adult users of a community IT centre
No full textThe Community IT centre (CITC) is a place where people engage in informal and formal activities leading topositive change in their lives. I undertook a multimodal, qualitative, participant-voice study based on the biographicalnarrative interpretive method (BNIM) at a CITC on a large housing estate in southern England, with 24 participants;11 people provided extended life stories. The study addresses the conspicuous silence of learners’ voices in theliterature about community education and gives space to the voices of users of the CITC. In the UK and elsewhere,the dominant route to social inclusion is presumed to be employment, for which IT skills are needed. The analysis,using a Third Space conceptual framework informed by Activity Theory, challenges this assumption. The studymakes specific and important contributions to knowledge about what people do with a CITC and makes policyrecommendations in line with the findings (Ch 9, section 9.5). The thesis shows that the CITC is a social learningspace, which supplies critically more IT access to those who don’t have “enough” and basic facilities to those whodon’t have IT at all.Positive change is manifested in an emergent, instrumental and interpersonal value system, discovered by thisresearch, consisting of compassion, determination, professionalism, resourcefulness, respect and solidarity. CITCsare shown to provide invaluable spaces within which identity projects may be pursued and the formation of selfeffective identities and communities supported. Through association with the CITC people can be enabled to bemore effective managers (and self-managers) of the institutions of society. Engagement with the CITC also appears to be associated with critical reflexivity concerning social presence and participation. People are discovered to have abroad range of motivations for using the centre and to do many things with computers. Affective factors are shown tobe significant in determining people’s use of IT. Although they do engender strong feelings, people’s relationshipwith computers is not fetishised nor do they form a particularly important aspect of identity. Despite assertions inpolicy about the importance of computers this thesis shows that IT is not the magnet that draws people intouncomfortable spaces; comfortable spaces draw people into IT use, and comfort is a factor of community.A common-sense of the self as the subject of a personal activity system – the institution of the individual – is a usefulunit of analysis however this is a complex notion. So too is the notion of community. People express forms of sharedexperience and interest, and negotiate concerns about identity on multiple scales (Panelli & Welch 2005). I takecommunity as a consistent “intersubjective network” (Žižek 2008, p.12), which, as for Bhabha, “... enables a divisionbetween the private and the public, the civil and the familial.” But, which also, “... enacts the impossibility of drawingan objective line between the two” (2004, p. 330). The stories of the participants reveal extensive hybridisation inrespect of many factors including: nationality, occupation, domesticity, social class, locale/neighbourhood, andexpectations of outcomes in life. Occupational identity: I am what I do – broadly conceived – is an important featureof participants' stories and there is wide community support for creative aspects of employment and for thetransformative potential for individuals and communities of working together, whether or not money is involved. Wider social institutions (family, education, work) are discovered to be highly productive in shaping people’s engagement with the CITC. Domestic circumstances and parenthood contribute significantly to people’s use of the centre. In particular, lone parenthood has a profound impact on people but can be a positive choice leading to a fulfilled sense of self and strong bond with the child, which can be facilitated by the CITC. Importantly, some people do not want the Internet in their homes. They resent its intrusion for strongly held reasons which need not be subject of argument or coercion. The thesis shows that participants in this study have a rich conceptualisation of learning, education, IT, qualifications and work, and clear understandings of the differences between formal and informal learning as well as an understanding of the multiply inscribed role of qualifications in social inclusion. The thesis provides specific local evidence for the OfCom (2010) findings about people’s preference for informal learning about ICT. The thesis recommends that communities take it upon themselves, with encouragement and support, to provide community IT centres
Intracerebral hemorrhage location and outcome among INTERACT2 participants
No full textObjective: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).
Methods: Associations between ICH sites and poor outcomes (death [6] or major disability [3–5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models.
Results: Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively).
Conclusion: Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule.
ClinicalTrials.gov registration: NCT00716079
