Petitions in the Epigraphic Record: Development of the Legal Order outside of the Imperial Hierarchy

The Roman imperial bureaucracy in the 2nd and 3rd centuries had expanded to include direct provincial administration, which led to disputes between imperial representatives and provincial subjects. To resolve these disputes, subjects turned to the burgeoning petition and response system of the Roman emperors, but the petitioners themselves lacked the legal education to effectively utilize precedent or rhetorical formulas. Despite this, fifteen petitions found in inscriptions from the 2nd and 3rd century AD in Latin and Greek from disparate regions contained the same structure and persuasive formulas. Based on these cross-empire similarities, I argue that these methods of presentation were maintained by legal counsels, whose services represented an organic growth of systematic aid based on the unmet needs of petitioners. Then, as a part of Diocletian’s reform, the content of petitions was used as a source of legal precedent and to identify issues in the provincial bureaucracy that needed resolution.Master of Art

MASTRO I: Meta-Analysis and Systematic Review of Thrombectomy Stent Retriever Outcomes: Comparing Functional, Safety and Recanalization Outcomes Between EmboTrap, Solitaire and Trevo in Acute Ischemic Stroke

Aims: Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences among SRs remain unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs: EmboTrap®, Solitaire™, and Trevo®. Methods: We conducted a PRISMA-compliant Systematic Review among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25 patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR). We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis were performed to explore heterogeneity. Results: Fifty-one articles comprising 9,804 patients were included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo (50.0%, p = 0.013) and Solitaire (45.3%, p \u3c 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%, p \u3c 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of recanalization; however, no statistically significant differences were found. Conclusion: The results of our Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT studies comparing different SR devices to confirm our findings

Physical activity level and stroke risk in US population: A matched case-control study of 102,578 individuals

Background: Stroke has been linked to a lack of physical activity; however, the extent of the association between inactive lifestyles and stroke risk has yet to be characterized across large populations. Purpose: This study aimed to explore the association between activity-related behaviors and stroke incidence. Methods: Data from 1999 to 2018 waves of the concurrent cross-sectional National Health and Nutrition Examination Survey (NHANES) were extracted. We analyzed participants characteristics and outcomes for all participants with data on whether they had a stroke or not and assessed how different forms of physical activity affect the incidence of disease. Results: Of the 102,578 individuals included, 3851 had a history of stroke. A range of activity-related behaviors was protective against stroke, including engaging in moderate-intensity work over the last 30 days (OR = 0.8, 95% CI = 0.7-0.9; P = 0.001) and vigorous-intensity work activities over the last 30 days (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001), and muscle-strengthening exercises (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001). Conversely, more than 4 h of daily TV, video, or computer use was positively associated with the likelihood of stroke (OR = 11.7, 95% CI = 2.1-219.2; P = 0.022). Conclusion: Different types, frequencies, and intensities of physical activity were associated with reduced stroke incidence, implying that there is an option for everyone. Daily or every other day activities are more critical in reducing stroke than reducing sedentary behavior duration

Toward Automated Data Extraction According to Tabular Data Structure: Cross-sectional Pilot Survey of the Comparative Clinical Literature

BackgroundSystematic reviews depend on time-consuming extraction of data from the PDFs of underlying studies. To date, automation efforts have focused on extracting data from the text, and no approach has yet succeeded in fully automating ingestion of quantitative evidence. However, the majority of relevant data is generally presented in tables, and the tabular structure is more amenable to automated extraction than free text. ObjectiveThe purpose of this study was to classify the structure and format of descriptive statistics reported in tables in the comparative medical literature. MethodsWe sampled 100 published randomized controlled trials from 2019 based on a search in PubMed; these results were imported to the AutoLit platform. Studies were excluded if they were nonclinical, noncomparative, not in English, protocols, or not available in full text. In AutoLit, tables reporting baseline or outcome data in all studies were characterized based on reporting practices. Measurement context, meaning the structure in which the interventions of interest, patient arm breakdown, measurement time points, and data element descriptions were presented, was classified based on the number of contextual pieces and metadata reported. The statistic formats for reported metrics (specific instances of reporting of data elements) were then classified by location and broken down into reporting strategies for continuous, dichotomous, and categorical metrics. ResultsWe included 78 of 100 sampled studies, one of which (1.3%) did not report data elements in tables. The remaining 77 studies reported baseline and outcome data in 174 tables, and 96% (69/72) of these tables broke down reporting by patient arms. Fifteen structures were found for the reporting of measurement context, which were broadly grouped into: 1×1 contexts, where two pieces of context are reported in total (eg, arms in columns, data elements in rows); 2×1 contexts, where two pieces of context are given on row headers (eg, time points in columns, arms nested in data elements on rows); and 1×2 contexts, where two pieces of context are given on column headers. The 1×1 contexts were present in 57% of tables (99/174), compared to 20% (34/174) for 2×1 contexts and 15% (26/174) for 1×2 contexts; the remaining 8% (15/174) used unique/other stratification methods. Statistic formats were reported in the headers or descriptions of 84% (65/74) of studies. ConclusionsIn this cross-sectional pilot review, we found a high density of information in tables, but with major heterogeneity in presentation of measurement context. The highest-density studies reported both baseline and outcome measures in tables, with arm-level breakout, intervention labels, and arm sizes present, and reported both the statistic formats and units. The measurement context formats presented here, broadly classified into three classes that cover 92% (71/78) of studies, form a basis for understanding the frequency of different reporting styles, supporting automated detection of the data format for extraction of metrics

Common Data Elements Reported in Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review of Active Clinical Trials

Background: New trials are planned regularly to provide the highest quality of evidence and invade new occlusion territories, which requires a pre-defined reporting strategy with consistent, common data elements for more straightforward collective evidence synthesis. We sought to review all active endovascular thrombectomy trials to investigate their patient selection criteria, intervention description, and reported outcomes. Methods: A literature search was systematically conducted on clinicaltrials.gov for active trials and all intervention, inclusion criteria, and outcomes reported were extracted. A qualitative synthesis of the frequency of study design types and data elements are graphically and narratively presented. Results: A total of 32 studies were tagged and included in the final qualitative analysis. The inclusion criteria were highly variable, including different cut-offs for the last well-known baseline National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and modified Rankin scale (mRS). Half of the studies (16/32) mentioned “thrombectomy” without defining which technique or device was used, and the final thrombolysis in cerebral infarction scale was provided in 19 (59.4%) studies. Heterogeneity was also present among the studies reporting a first-pass effect, both in how studies defined the outcome and in used ranges for mRS. Mortality and intracerebral hemorrhage (ICH) were more homogenous in their presentation and follow-up. Conclusions: There is a great degree of heterogeneity in the active thrombectomy trials concerning inclusion criteria, interventions used, and how outcomes are being reported

Correction: Web-Based Software Tools for Systematic Literature Review in Medicine: Systematic Search and Feature Analysis

BACKGROUND: Systematic reviews (SRs) are central to evaluating therapies but have high costs in terms of both time and money. Many software tools exist to assist with SRs, but most tools do not support the full process, and transparency and replicability of SR depend on performing and presenting evidence according to established best practices. OBJECTIVE: This study aims to provide a basis for comparing and selecting between web-based software tools that support SR, by conducting a feature-by-feature comparison of SR tools. METHODS: We searched for SR tools by reviewing any such tool listed in the SR Toolbox, previous reviews of SR tools, and qualitative Google searching. We included all SR tools that were currently functional and required no coding, and excluded reference managers, desktop applications, and statistical software. The list of features to assess was populated by combining all features assessed in 4 previous reviews of SR tools; we also added 5 features (manual addition, screening automation, dual extraction, living review, and public outputs) that were independently noted as best practices or enhancements of transparency and replicability. Then, 2 reviewers assigned binary present or absent assessments to all SR tools with respect to all features, and a third reviewer adjudicated all disagreements. RESULTS: Of the 53 SR tools found, 55% (29/53) were excluded, leaving 45% (24/53) for assessment. In total, 30 features were assessed across 6 classes, and the interobserver agreement was 86.46%. DistillerSR (Evidence Partners; 26/30, 87%), Nested Knowledge (Nested Knowledge; 25/30, 83%), and EPPI-Reviewer Web (EPPI-Centre; 24/30, 80%) support the most features followed by Giotto Compliance (Giotto Compliance; 23/30, 77%), LitStream (ICF), and SRDB.PRO (VTS Software). Fewer than half of all the features assessed are supported by 7 tools: RobotAnalyst (National Centre for Text Mining), SRDR (Agency for Healthcare Research and Quality), SyRF (Systematic Review Facility), Data Abstraction Assistant (Center for Evidence Synthesis in Health), SR Accelerator (Institute for Evidence-Based Healthcare), RobotReviewer (RobotReviewer), and COVID-NMA (COVID-NMA). Notably, of the 24 tools, only 10 (42%) support direct search, only 7 (29%) offer dual extraction, and only 13 (54%) offer living/updatable reviews. CONCLUSIONS: DistillerSR, Nested Knowledge, and EPPI-Reviewer Web each offer a high density of SR-focused web-based tools. By transparent comparison and discussion regarding SR tool functionality, the medical community can both choose among existing software offerings and note the areas of growth needed, most notably in the support of living reviews

Carotid endarterectomy versus carotid stenting for asymptomatic carotid stenosis: Evaluating the overlapping meta-analyses of randomized controlled trials

Background: Asymptomatic carotid stenosis is associated with increased risk of ischemic stroke. The management of asymptomatic carotid stenosis ranges from open surgical approaches, minimally invasive endovascular interventions, and medical therapeutics. However, the research synthesis comparing these interventions, as shown by the scattered and overlapping published meta-analysis, has been inconsistent and non-comprehensive. Methods: Using previously-employed methods, we searched for and compared published meta-analyses comparing carotid endarterectomy and carotid stenting. A comprehensive search was conducted for all relevant studies published until November 13th, 2021, using the following databases: PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, OVID, and Google Scholar. Results: Five meta-analysis studies were included in this review. In summary, clinical findings were: carotid endarterectomy reduced the rate of ischemic stroke and stroke-related mortality, but led to a higher rate of intraoperative cranial nerve injury. There was no significant difference between carotid endarterectomy and carotid stenting in ipsilateral stroke and myocardial infarction events. Conclusions: The clinical findings favor the carotid endarterectomy over the carotid stenting in terms of stroke incidence (overall and minor events) and stroke-related mortality rates. However, the carotid stenting was superior to the carotid endarterectomy in the events of cranial nerve injury during the intervention

sj-xlsx-1-ine-10.1177_15910199231188763 - Supplemental material for Hypoperfusion intensity ratio as a predictor of outcomes after thrombectomy triage: A call for data homogeneity

Supplemental material, sj-xlsx-1-ine-10.1177_15910199231188763 for Hypoperfusion intensity ratio as a predictor of outcomes after thrombectomy triage: A call for data homogeneity by Gautam Adusumilli, Hassan Kobeissi, Sherief Ghozy, Kevin M. Kallmes, Waleed Brinjikji, David Kallmes and Jeremy J. Heit in Interventional Neuroradiology</p

Abstract Number ‐ 95: Common Data Elements Analysis of Mechanical Thrombectomy Clinical Trials for Acute Ischemic Large Core Stroke

Introduction Various clinical trials addressing large core acute ischemic stroke (AIS) are ongoing from multiple international groups. Future development of clinical guidelines depends on meta‐analyses of these trials calling for a degree of homogeneity of elements across the different studies. The aim of this common data element study was to provide an overview of the key features of pertinent large core infarct trials. Methods PubMed and ClinicalTrials.gov databases were screened for published and ongoing clinical trials assessing mechanical thrombectomy in patients with AIS with large core infarct. Nested Knowledge AutoLit living review platform was utilized to categorize primary and secondary outcomes as well as inclusion and exclusion criteria for patient selection in the clinical trials. Results The most reported data element was ASPECTS score, but with varied definitions of what compromises large core. Non‐utility‐weighted modified Rankin Score (mRS) was reported in 6/7 studies as the primary outcome, while the utility‐weighted mRS was the outcome of interest in the TESLA trial, all of them at the 3‐months mark, with only LASTE looking for mRS shift at the 6‐months mark. Secondary outcomes had more variations. Mortality is reported separately only in 4/7 trials, all at the 3‐month mark. Additionally, the TENSION trial reports the frequency of serious adverse events, including mortality, at the 1‐week and 12‐month mark. Conclusions In the published and the ongoing large core trials, there is a large degree of variability in the collected data elements. Differences in definition and timepoints renders reaching a unified standard difficult, which hinders high quality meta‐analyses and cohesive evidence‐driven synthesis