Association of hyperdense middle cerebral artery sign with clinical outcome in patients treated with tissue plasminogen activator.

The hyperdense middle cerebral artery sign (HMCAS) is a marker of thrombus in the middle cerebral artery. The aim of our study was to find out the frequency of the HMCAS, its association with initial neurological severity and early parenchymal ischemic changes on CT, its relevance to clinical outcome, and the efficacy of intravenous recombinant tissue plasminogen activator (rtPA) in patients with the HMCAS.Secondary analysis of the data from 620 patients who received either rtPA or placebo in the European Cooperative Acute Stroke Study I (ECASS I), a double-blind, randomized, multicenter trial. The baseline CT scans were obtained within 6 hours from the onset of symptoms. Functional and neurological outcomes were assessed using the modified Rankin Scale and the Scandinavian Stroke Scale at day 90.We found an HMCAS in 107 patients(17.7\%). The initial neurological deficit was more severe in patients with the HMCAS than in those lacking this sign (P<0.0001). Early cerebral edema and mass effect were also more common in patients with the HMCAS (P<0.0001). The HMCAS was related to the risk of poor functional outcome (grade of 3 to 6 on the modified Rankin Scale) on univariate analysis: 90 patients (84\%) with the HMCAS and 310 patients (62\%) lacking this sign were dependent or dead at day 90 (P<0.0001). However, this association was no longer significant in a logistic model accounting for the effect of age, sex, treatment with rtPA, initial severity of neurological deficit and early parenchymal ischemic changes on CT. Patients with the HMCAS who were given rtPA had better neurological recovery than those who received placebo (P=0.0297).The HMCAS is associated with severe brain ischemia and poor functional outcome. However, it has no significant independent prognostic value when accounting for the effect of initial severity of neurological deficit and of early parenchymal ischemic changes on CT. Patients with the HMCAS may benefit from intravenous rtPA

From work to retirement

This entry aims at proposing theoretical and pratical aspects related to the transition from work to retirement. The major psychosocial theoretical models that try to explain this transition are presented. Individual and contextual (organizational) factors that influence the nature and quality of the transition to retirement are then discussed. Finally, bridge employment are presented as a pragmatic way adopted by workers and organizations to have a progressive transition from full employment to full retirement

Self-transcendent positive emotions increase spirituality through basic world assumptions

Spirituality has mostly been studied in psychology as implied in the process of overcoming adversity, being triggered by negative experiences, and providing positive outcomes. By reversing this pathway, we investigated whether spirituality may also be triggered by selftranscendent positive emotions, which are elicited by stimuli appraised as demonstrating higher good and beauty. In two studies, elevation and/or admiration were induced using different methods. These emotions were compared to two control groups, a neutral state and a positive emotion (mirth). Self-transcendent positive emotions increased participants’ spirituality (Studies 1 and 2), especially for the non-religious participants (Study 1). Two basic world assumptions, i.e., belief in life as meaningful (Study 1) and in the benevolence of others and the world (Study 2) mediated the effect of these emotions on spirituality. Spirituality should be understood not only as a coping strategy, but also as an upward spiraling pathway to and from self-transcendent positive emotions

Intentions to continue working and its predictors

The chapter addresses the concept of intention to continue working among older workers. How can it be defined ? How is it different or related to concepts such as work motivation, commitment and intention to retire early ? We review the findngs regarding the personal, orgnaizational and context factors that predict it. We discuss Human Resource Management practices that could influence employee intentions to continue working