Framing by media and social movement organizations: Cross-cultural prestige press coverage of the Kyoto Protocol

This dissertation examines the effects of news values and media routines on the framing of societal issues, with emphasis on cross-cultural prestige press coverage of the Kyoto Protocol. Media use news values to determine what makes the daily news and how that news is portrayed to the public. Journalists selectively choose news stories based on media routines, which help in gathering and disseminating the news in an efficient manner. Stakeholders attempt to frame the news in a manner worthy of news coverage, but media primarily report on the acceptance of or opposition to master frames. Evidence of this interplay exists when examining contentious issues like that of Kyoto Protocol. To find evidence of these processes, a computerized content analysis using the VBPro suite of programs examined 421 American prestige press articles, 721 British prestige press articles, 112, news releases and 443 opinion pieces appearing from January 1997 to Sept. 11, 2001. The texts were gathered from the Lexis-Nexis and Dow Jones databases. Hierarchical cluster analysis provided visual representations of the frames involved. The focus on prestige press coverage limits the external validity of the findings. The analysis uncovered four master frames supported by 10 stakeholder frames concerning global climate change and the Kyoto Protocol. The news value of prominence affected the master frames, though not in the predicted manner concerning stakeholder support or opposition. However, historical analysis indicates support for previous research that indicated international politics held sway over the issue. The analysis also found evidence of media routines at work, including gatekeeping, balancing competing positions and the spiral of opportunity. Theoretically, this dissertation provides a synthesis of communications and sociological literature, and a cross-cultural comparison of an international environmental issue. Methodologically, VBPro was shown to quantify master frames, which may be the first time this has happened. Practically, the dissertation provides an explanation to journalists and stakeholders in government, science, business, and social movement organizations of how news values and media routines lead to the acceptance or rejection of issue frames, as well as the possible de-legitimization of sources outside the media routine

Clinical and Neuroimaging Outcomes of Direct Thrombectomy vs Bridging Therapy in Large Vessel Occlusion Analysis of the SELECT Cohort Study

Objective To evaluate the comparative safety and efficacy of direct endovascular thrombectomy (dEVT) compared to bridging therapy (BT; IV tissue plasminogen activator + EVT) and to assess whether BT potential benefit relates to stroke severity, size, and initial presentation to EVT vs non-EVT center. Methods In a prospective multicenter cohort study of imaging selection for endovascular thrombectomy (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke [SELECT]), patients with anterior circulation large vessel occlusion (LVO) presenting to EVT-capable centers within 4.5 hours from last known well were stratified into BT vs dEVT. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0-2). Secondary outcomes included a shift across 90-day mRS grades, mortality, and symptomatic intracranial hemorrhage. We also performed subgroup analyses according to initial presentation to EVT-capable center (direct vs transfer), stroke severity, and baseline infarct core volume. Results We identified 226 LVOs (54% men, mean age 65.6 +/- 14.6 years, median NIH Stroke Scale [NIHSS] score 17, 28% received dEVT). Median time from arrival to groin puncture did not differ in patients with BT when presenting directly (dEVT 1.43 [interquartile range (IQR) 1.13-1.90] hours vs BT 1.58 [IQR 1.27-2.02] hours, p = 0.40) or transferred to EVT-capable centers (dEVT 1.17 [IQR 0.90-1.48] hours vs BT 1.27 [IQR 0.97-1.87] hours, p = 0.24). BT was associated with higher odds of 90-day functional independence (57% vs 44%, adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.01-4.03, p = 0.046) and functional improvement (adjusted common OR 2.06, 95% CI 1.18-3.60, p = 0.011) and lower likelihood of 90-day mortality (11% vs 23%, aOR 0.20, 95% CI 0.07-0.58, p = 0.003). No differences in any other outcomes were detected. In subgroup analyses, patients with BT with baseline NIHSS scores <15 had higher functional independence likelihood compared to those with dEVT (aOR 4.87, 95% CI 1.56-15.18, p = 0.006); this association was not evident for patients with NIHSS scores >= 15 (aOR 1.05, 95% CI 0.40-2.74, p = 0.92). Similarly, functional outcomes improvements with BT were detected in patients with core volume strata (ischemic core <50 cm(3): aOR 2.10, 95% CI 1.02-4.33, p = 0.044 vs ischemic core >= 50 cm(3): aOR 0.41, 95% CI 0.01-16.02, p = 0.64) and transfer status (transferred: aOR 2.21, 95% CI 0.93-9.65, p = 0.29 vs direct to EVT center: aOR 1.84, 95% CI 0.80-4.23, p = 0.15). Conclusions BT appears to be associated with better clinical outcomes, especially with milder NIHSS scores, smaller presentation core volumes, and those who were “dripped and shipped.” We did not observe any potential benefit of BT in patients with more severe strokes