Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.The International Takotsubo Registry was supported by the Biss Davies Charitable Trust. Dr. Scheitz has been supported by the Corona Foundation. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation.info:eu-repo/semantics/publishedVersio

Engaging students in life and literature: a qualitative study of rural north Alabama community college american literature instructors' course design and pedagogical practices

The purpose of this qualitative study was to examine the course design decisions and pedagogical practices of American literature teachers at three rural community colleges of varying size in North Alabama. Fink's (2003) Integrated Course Design (ICD) model provided a framework for this study, and the researcher attempted to determine if and to what degree rural community college American literature instructors reflect the over-arching qualities and components of Fink's ICD model. The participants in this study were ten full-time community college American literature instructors of varying ages, educational backgrounds, and years of teaching experience; the participant group included five male and five female instructors. Data for the study were derived from interviews with each instructor, classroom observations, and review of course-related documents. Using basic qualitative methods, the researcher conducted a thematic analysis of the data, which enabled him to organize the qualitative data into manageable strands. Using the study's theoretical framework as a basis for coding the data, the researcher was able to establish connections between the collected data and the research questions. Four themes emerged from data analysis: (a) Situational Factors Affect Course Design and Instructional Decisions; (b) Academically Unprepared Students Affect Course Design and Instructional Decisions; (c) Instruction Should Be Engaging and the Subject Matter Should Be Relevant to Students' Lives; and (d) American Literature Instructors Should Be Reflective Practitioners. The researcher found that participants did consider certain situational factors as they planned for and delivered their courses. Also, the data proved that instructors gave little consideration to the learning goals as they planned and delivered their courses. Similarly, the researcher discovered that participants did not plan teaching and learning activities in advance, nor did they work to ensure alignment with the learning goals or assessments. Finally, findings suggest that the participants spent little time planning or working to ensure the integration of Fink's (2003) four components of course design; when it occurred, integration happened inadvertently. The participants' course design decisions and pedagogical practices only partially reflect the tenets of Fink's Integrated Course Design Model. (Published By University of Alabama Libraries