Does hemispheric lateralization influence functional and cardiovascular outcomes after stroke?: an analysis of placebo-treated patients from prospective acute stroke trials

<p><b>Background and Purpose:</b> The influence of stroke lateralization on functional and cardiovascular outcome after stroke is not well established. We evaluated the influence of hemispheric lateralization among patients enrolled in prospective acute stroke trials.</p> <p><b>Methods:</b> We obtained data from the VISTA database for acute stroke trials which reported lateralization. Baseline data, cardiac adverse events, and 90-day outcomes were compared between right and left hemisphere stroke patients. A "hemisphere unbiased" subscore of the NIHSS which omitted items strongly associated with lateralized cognitive deficits was also compared for trials which reported individual NIHSS item scores. A multivariable analysis of outcome predictors was performed.</p> <p><b>Results:</b> Three acute stroke trials met the prespecified inclusion criteria. 1644 placebo-treated patients with documented hemispheric lateralization were included in the analysis. Baseline NIHSS was higher for left hemisphere patients (mean 16.2, versus 12.8 right, P < 0.001); there was no difference in the "hemisphere unbiased" NIHSS subscore (10.88 left, 11.08 right, n=687, P= 0.49). There was no difference between hemispheres in 90-day modified Rankin Score (3.43 left, 3.29 right, P=0.13), mortality (22.1% left, 19.5% right, P=0.20), or cardiac adverse events (P=0.71). Hemispheric lateralization was not an independent predictor of outcome in the multivariable analysis after controlling for the hemispheric bias intrinsic to the NIHSS.</p> <p><b>Conclusions:</b> There is no difference in functional outcome between patients with right or left hemisphere stroke. Use of the baseline NIHSS score to predict stroke outcome must take hemispheric lateralization into account. Stroke lateralization is not an important predictor of cardiac adverse events or 90-day mortality.</p&gt

Thrombolysis is associated with consistent functional improvement across baseline stroke severity: a comparison of outcomes in patients from the Virtual International Stroke Trials Archive (VISTA)

<p><b>Background and Purpose:</b> Baseline stroke severity predicts outcomes among thrombolysed patients. The baseline National Institutes of Health Stroke Scale (NIHSS) thresholds are sometimes used to select patients for thrombolysis, clinical trial enrollment, or both. Using data lodged with Virtual International Stroke Trials Archive, we compared adjusted outcomes between thrombolysed and nonthrombolysed patients enrolled in neuroprotection trials (1998-2007) to assess the influence of various levels of baseline NIHSS.</p> <p><b>Method:</b> We assessed the association of treatment with outcome, measured across the modified Rankin scale score distribution, in patients categorized by baseline NIHSS in increments of 4. We used an age and baseline NIHSS adjusted Cochran-Mantel-Haenszel test followed by proportional odds logistic regression analysis. We report the Cochran-Mantel-Haenszel P values and estimated odds ratios (OR) for improved modified Rankin scale score distribution with treatment for patients within each baseline NIHSS category.</p> <p><b>Results:</b> Data were available for 5817 patients (1585 thrombolysed and 4232 nonthrombolysed). Baseline severity was greater among thrombolysed than nonthrombolysed (median baseline NIHSS, 14 vs 13; P<0.05). An association of treatment with outcome was seen independently and was of similar magnitude within each of the baseline NIHSS categories 5 to 8 (P=0.04; OR, 1.25; 95% confidence interval [CI], 1.0-1.6; N=278/934 thrombolysed/nonthrombolysed), 9 to 12 (P=0.01; OR, 1.3; 95% CI, 1.1-1.6; N=404/942), 13 to 16 (P<0.05; OR, 1.6; 95% CI, 1.3-2.1; N=342/814), 17 to 20 (P<0.05; OR, 1.7; 95% CI, 1.3-2.1; N=311/736), and 21 to 24 (P<0.05; OR, 1.6; 95% CI, 1.1-2.1; N=178/466). No association was observed within baseline NIHSS categories 1 to 4 (P=0.8; OR, 1.1; 95% CI, 0.3-4.4; N=8/161) or >= 25 (P=0.08; OR, 1.1; 95% CI, 0.7-1.9; N=64/179).</p> <p><b>Conclusions:</b> In this nonrandomized comparison, outcomes after thrombolysis were significantly better than in untreated comparators across baseline NIHSS 5 to 24. The significant association was lost only at extremes of baseline NIHSS when sample sizes were small and confidence limits were wide.</p&gt

Alien Registration- Lyden, John (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/23690/thumbnail.jp

In France, Michelle is a Man\u27s Name

This is a review of the short film, In France, Michelle is a Man\u27s Name (2021), directed by Em Weinstein

Job Satisfaction and Empowerment of Self-Employed Nurse Practitioners: A Mixed Methods Study

Background and Purpose: Self-employed nurse practitioners (NPs) have been part of the American health care landscape since the 1980s, owning practices throughout the United States. The purpose of this study was to explore the lived experience of self-employed NPs, focusing on their level of job satisfaction and perceived level of empowerment. Methods: The study was a convergent-parallel designed, mixed-method study, utilizing a survey and semi-structured interviews. The survey included the Misener Job Satisfaction Survey (MJSS) and Conditions of Work Effectiveness Questionnaire II (CWEQ-II) Conclusions: A total of 142 surveys and 13 interviews were completed and analyzed. Nurse practitioners in private practice are both satisfied and empowered, irrespective of practice environment. The more empowered, the higher their level of job satisfaction. Over 40% practiced with full practice authority, in a rural location and 50% had over 10 years’ experience as both an RN and NP. Their experience in private practice was explored further in the interviews. Implications: This study identifies barriers to job satisfaction and empowerment in self-employed NPs, including physician oversight and lack of business management education. Continuing work to remove, restrictive and reduced state regulatory environments, as well as education on business management, may increase the number of NPs in private practice, expanding access to health care for the American people

The Ongoing Ebola Epidemic in the Democratic Republic of the Congo: Contributing Factors that have Influenced Disease Control

Ebolavirus outbreaks and epidemics have affected regions of Africa since its discovery in 1976. Presently, the Democratic Republic of the Congo (DRC) is experiencing its tenth and largest outbreak of Ebolavirus, infecting nearly 3,432 individuals and causing 2,253 deaths. First declared an official outbreak on August 1, 2018, the DRC Ministry of Health (MOH) and other global health institutions are having difficulties in controlling the spread of infection due to community resistance and mistrust, poor healthcare infrastructures, political conflict, civil unrest, and porous geographic boundaries. A literature review and analysis were performed to evaluate contributing factors to the ongoing outbreak in the DRC. In this essay, I outline the contributing factors that have led to the continuity of the ebolavirus epidemic in the DRC and predict long-term effects it may have on the country. By analyzing up-to-date World Health Organization (WHO) situation reports, journal articles, and newspaper reports, I have found that in order to sufficiently control the outbreak, continued surveillance and contact tracing is required in combination with building community trust and transparency. It is important to understand outbreak and infection control measures in historically underdeveloped areas, especially those with poor healthcare infrastructure and politically unstable environments. By gaining insight on the successes and shortcomings of specific public health control measures, health ministries and global health organizations can improve upon their actions and distribution of resources in times of dangerous outbreaks

Economic Talc Deposits of Montana and Related Firing Problems

This thesis has to do with a study of the produc­tion of talc in Montana, describing the local geology of each deposit, and a description of the laboratory tests that were made on various grades of Montana talc in an attempt to determine why some grades of talc can be burned in solid forms while others must be ground, mixed with a binder and molded

Divine Love

This is a film review of Divine Love (2019) directed by Gabriel Mascaro