Predictors of Poststroke Aphasia Recovery

Background and Purpose: The factors associated with recovery of language domains after stroke remain uncertain. We described recovery of overall-language-ability, auditory comprehension, naming, and functional-communication across participants’ age, sex, and aphasia chronicity in a large, multilingual, international aphasia dataset. Methods: Individual participant data meta-analysis of systematically sourced aphasia datasets described overall-language ability using the Western Aphasia Battery Aphasia-Quotient; auditory comprehension by Aachen Aphasia Test (AAT) Token Test; naming by Boston Naming Test and functional-communication by AAT Spontaneous-Speech Communication subscale. Multivariable analyses regressed absolute score-changes from baseline across language domains onto covariates identified a priori in randomized controlled trials and all study types. Change-from-baseline scores were presented as estimates of means and 95% CIs. Heterogeneity was described using relative variance. Risk of bias was considered at dataset and meta-analysis level. Results: Assessments at baseline (median=43.6 weeks poststroke; interquartile range [4–165.1]) and first-follow-up (median=10 weeks from baseline; interquartile range [3–26]) were available for n=943 on overall-language ability, n=1056 on auditory comprehension, n=791 on naming and n=974 on functional-communication. Younger age (<55 years, +15.4 Western Aphasia Battery Aphasia-Quotient points [CI, 10.0–20.9], +6.1 correct on AAT Token Test [CI, 3.2–8.9]; +9.3 Boston Naming Test points [CI, 4.7–13.9]; +0.8 AAT Spontaneous-Speech Communication subscale points [CI, 0.5–1.0]) and enrollment <1 month post-onset (+19.1 Western Aphasia Battery Aphasia-Quotient points [CI, 13.9–24.4]; +5.3 correct on AAT Token Test [CI, 1.7–8.8]; +11.1 Boston Naming Test points [CI, 5.7–16.5]; and +1.1 AAT Spontaneous-Speech Communication subscale point [CI, 0.7–1.4]) conferred the greatest absolute change-from-baseline across each language domain. Improvements in language scores from baseline diminished with increasing age and aphasia chronicity. Data exhibited no significant statistical heterogeneity. Risk-of-bias was low to moderate-low. Conclusions: Earlier intervention for poststroke aphasia as crucial to maximize language recovery across a range of language domains, although recovery continued to be observed to a lesser extent beyond 6 months poststroke

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Measuring political risk as risks to foreign investment : a computer-assisted model for analysing and managing political risk

Thesis (PhD)--University of Stellenbosch, 2002.ENGLISH ABSTRACT: As the title suggests, the major challenge that this study faces is to set out and design a model for analysing and enabling the management of political risk as investment risk - a model that is both sensitive to and reflective of the comprehensive business and investment climate in a country, not only credit or country risk, or only pure political risk in its narrowest definition. In reading about past and more recent research in the field of political risk analysis, it becomes clear that many authors begin by noting the diversity and the discrepancies of the existing definitions of political risk, but evidence in political risk insurance shows that the major perceived political risks that investors insure their interests against seem to be confiscation, expropriation and nationalisation. In the light of this study's findings though, a case can be put forward for urging that the conceptualisation of political risk be extended to further include any or all of the micro political risk factors and their indicators that have been identified to ensure that political events do not impact negatively on a foreign company's profitability. Foreign investors put assets at risk to achieve their objectives and the assessment of these risks, including political risks, is the key to successful operations. Opportunities and risks are often two sides of the same coin and political risk comprises a large part of the environmental forces in terms of the management challenges a Multinational Company (MNC) faces in any investment climate. A firm's foreign investment strategy deals with the positioning of the organisation in an uncertain host country environment and investment climate. This study attempts to explain how a firm's political risk exposure, which refers to the sensitivity of a firm's projected profitability and operationability in a host country to changes in the investment climate, could be managed and reduced. It is hoped that political risk analysis and management can assist foreign operations in managing the risks that might have otherwise proven to be destructive to profitability and operationability. It is irresponsible to present a potential investor with a risk assessment that does not incorporate political risk factors and their indicators, let alone environmental, societal and socio-economic risk factor indicators. Ultimately any business climate, regardless of the country being studied, is underwritten by a political system, political climate, political culture and business culture of the system in which foreign business wishes to operate profitably. What is often labelled as unnecessary and irrelevant detail in risk analysis often results in a lack of using micro risk factors and their indicators and an underestimation of the importance of such micro risk indicators. Hopefully this study takes up the challenge of showing that political risk can be managed and political risk analysis can be made more precise - that it is possible to measure and manage political risk.AFRIKAANSE OPSOMMING: Soos die titel van hierdie studie voorstel is een van die grootste uitdagings die ontwerp van 'n model vir die analise van politieke risiko as beleggingsrisiko - 'n model wat ter selfde tyd sensitief is vir en weerspieëlend van 'n land se algemeen omvattende besigheids- en beleggingsklimaat, en nie slegs suiwer politieke risiko in die nouste sin van die woord nie. 'n Literatuurstudie van meer onlangse navorsing, asook navorsing wat in die verlede gedoen is oor politieke risiko en die analise daarvan, dui daarop dat baie outeurs melding maak van die diversiteit en teenstrydighede in die bestaande definisies van politieke risiko. Die teenwoordigheid van versekering teen politieke risiko wys egter daarop dat die primêre politieke risiko's waarteen beleggers hulle belange verseker meesal nasionalisering en onteiening is, asook die beslaglegging op beleggings. Teen die agtergrond van hierdie studie se bevindinge, kan daar egter 'n saak uitgemaak word vir die verbreeding van die konseptualisering van politieke risiko om enige of alle van die mikro-politieke risiko faktorindikatore wat in hierdie studie identifiseer word in te sluit, om sodoende te verseker dat die negatiewe gevolge wat politieke gebeure moontlik mag inhou vir 'n buitelandse maatskappy se belange, sover moontlik beperk word. Buitelandse beleggers stel bates bloot aan risiko's ten einde voorafgestelde doelwitte te bereik en die assessering van hierdie risiko's, insluitende politieke risiko's, is 'n groot bydraende' faktor tot die suksesvolle bedryf van buitelandse beleggings. Geleenthede en risiko's is dikwels twee kante van diesIefde muntstuk en politieke risiko maak 'n groot deel uit van die uitdagende beleggingsomgewing waarin die bestuur van 'n multinasionale korporasie (MNK) daagliks moet funksioneer. 'n Maatskappy se buitelandse beleggingstrategie handel met die posisionering van die organisasie in die onvoorspelbare beleggingsklimaat van 'n vreemde land. Hierdie studie poog ook om te verduidelik hoe die mate waarin 'n firma blootgestel word aan politieke risiko, met ander woorde die sensitiwiteit van 'n firma se voorgenome winsgewendheid en bedryf teenoor veranderinge in die beleggingsklimaat van 'n vreemde land, bestuur en verminder kan word. Daar word gehoop dat politieke risiko analise en die bestuur daarvan 'n bydra kan lewer tot buitelandse besighede se bestuur van hierdie risiko's, wat andersins 'n vemietgende impak kan hê op die winsgewendheid van buitelandse bedrywighede. Dit is onverantwoordelik om aan 'n buitelandse belegger 'n risiko analise voor te lê wat nie politieke risiko faktore en die daarmee gepaardgaande indikatore insluit nie. Die studie argumenteer verder dat faktorindikatore wat die fisiese omgewing, sosiale asook sosio-ekonomiese faktore aanspreek ook in 'n risiko analise ingesluit moet word. Oplaas is enige besigheidsklimaat, nieteenstaande die land wat bestudeer word, onderskryf deur 'n politieke stelsel, politieke klimaat, politieke kultuur en besigheidskultuur van die stelsel waarin die buitelandse besigheid winsgewende resultate as doelwit het. Wat dikwels beskou word as onnodige en irrelevante detail in risiko analise lei dikwels tot 'n gebrek aan die insluiting van mikro-risiko faktore en hulle indikatore weens 'n onderskatting van die noodsaaklikheid daarvan om juis sulke mikro-risiko faktorindikatore in 'n risiko analise in te bou. Hierdie studie aanvaar hopelik die uitdaging om te wys dat politieke risiko tog bestuur kan word en dat politieke risiko analise tog meer eksak gemaak kan word - dat dit wel moontlik is om politieke risiko te meet en bestuur

Frequency and characteristics of immune-related thyroid adverse events in patients with resected stage III/IV melanoma treated with adjuvant PD-1 inhibitors: a national cohort study

PURPOSE: Immune-related thyroid adverse events (irTAEs) occur frequently following immune checkpoint inhibitor (ICI) therapy. The purpose of this study is to provide knowledge about the incidence, clinical timeline characteristics, associated factors of irTAEs, and potential impact on treatment efficacy in patients with melanoma receiving adjuvant ICI therapy.METHODS: A national multicenter retrospective cohort study of patients with resected stage III/IV melanoma treated with adjuvant PD-1 inhibitors between November 2018 and December 2020. Data were extracted from the Danish Metastatic Melanoma Database. The irTAEs were defined as two consecutive abnormal TSH values and subdivided into transient or persistent.RESULTS: Of 454 patients, 99 developed an irTAE (21.8%), of these were 46 transient (46.5%) and 53 persistent (53.5%). Median time to transient and persistent irTAE was 55 and 44 days, respectively (p = 0.57). A hyperthyroid phase followed by hypothyroidism was seen in 73.6% of persistent irTAEs, whereas 87% of transient irTAEs developed an isolated hypo- or hyperthyroid phase. Multiple variable analysis demonstrated an association between irTAE and female sex (HR 2.45; 95% CI 1.63-3.70; p &lt; 0.001), but no association with recurrence-free survival (HR 0.86; 95% CI 0.50-1.48; p = 0.587) or overall survival (HR 1.05; 95% CI 0.52-2.12, p = 0.891).CONCLUSIONS: IrTAE is a common side effect to PD-1 inhibitors primarily occurring within the first 3 months, with a high risk of persistency. Female sex is a strong predictive factor. IrTAE was not associated with improved clinical outcome.</p

Growing a circular economy with fungal biotechnology: A white paper

publishedVersio

Multi-institutional Quantitative Evaluation and Clinical Validation of Smart Probabilistic Image Contouring Engine (SPICE) Autosegmentation of Target Structures and Normal Tissues on Computer Tomography Images in the Head and Neck, Thorax, Liver, and Male

<p>Purpose: Clinical validation and quantitative evaluation of computed tomography (CT) image autosegmentation using Smart Probabilistic Image Contouring Engine (SPICE).</p><p>Methods and Materials: CT images of 125 treated patients (32 head and neck [HN], 40 thorax, 23 liver, and 30 prostate) in 7 independent institutions were autosegmented using SPICE and computational times were recorded. The number of structures autocontoured were 25 for the HN, 7 for the thorax, 3 for the liver, and 6 for the male pelvis regions. Using the clinical contours as reference, autocontours of 22 selected structures were quantitatively evaluated using Dice Similarity Coefficient (DSC) and Mean Slice-wise Hausdorff Distance (MSHD). All 40 autocontours were evaluated by a radiation oncologist from the institution that treated the patients.</p><p>Results: The mean computational times to autosegment all the structures using SPICE were 3.1 to 11.1 minutes per patient. For the HN region, the mean DSC was > 0.70 for all evaluated structures, and the MSHD ranged from 3.2 to 10.0 mm. For the thorax region, the mean DSC was 0.95 for the lungs and 0.90 for the heart, and the MSHD ranged from 2.8 to 12.8 mm. For the liver region, the mean DSC was > 0.92 for all structures, and the MSHD ranged from 5.2 to 15.9 mm. For the male pelvis region, the mean DSC was > 0.76 for all structures, and the MSHD ranged from 4.8 to 10.5 mm. Out of the 40 autocontoured structures reviews by experts, 25 were scored useful as autocontoured or with minor edits for at least 90% of the patients and 33 were scored useful autocontoured or with minor edits for at least 80% of the patients.</p><p>Conclusions: Compared with manual contouring, autosegmentation using SPICE for the HN, thorax, liver, and male pelvis regions is efficient and shows significant promise for clinical utility. (C) 2013 Elsevier Inc.</p>