Public attitudes toward forest management practices on pulp and paper company-owned forest lands in the southern Appalachian Region

Twenty-three community organizations participated in an educational program that addressed forest management practices on pulp and paper company-owned forest lands (for clarification, pulp and paper companies will be referred to as forest industry) in the Southern Appalachian Region. Initial attitudes were assessed using a pre-program questionnaire that focused on forest management practices on industry-owned land in the Southern Appalachian Region. An educational program was presented that addressed clearcutting, pine management, and erosion and sedimentation. The same questionnaire was then administered to identify any attitude changes that could be attributed to the educational program. This program was presented to several group-types which included church, civic, environmental, and professional groups in Asheville, North Carolina, Chattanooga, Tennessee, and Knoxville, Tennessee. The results suggest that the study population had generally supportive attitudes about industry. The educational program produced significant changes in attitudes in that respondents were more supportive in general. Finally, the attitudes of environmental groups changed most noticeably from non-supportive to generally supportive of industries current management practices

Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS

Background and Purpose: Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population. Methods: This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase. Results: A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded (<1%). Conclusions: A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02072681