Can we improve the statistical analysis of stroke trials? Statistical re-analysis of functional outcomes in stroke trials

Background: Most large acute stroke trials have been neutral. Functional outcome is usually analysed using a yes or no answer, e.g. death or dependency vs. independence. We assessed which statistical approaches are most efficient in analysing outcomes from stroke trials. Methods: Individual patient data from acute, rehabilitation and stroke unit trials studying the effects of interventions which alter functional outcome were assessed. Outcomes included modified Rankin Scale, Barthel Index, and ‘3 questions’. Data were analysed using a variety of approaches which compare two treatment groups. The results for each statistical test for each trial were then compared. Results: Data from 55 datasets were obtained (47 trials, 54,173 patients). The test results differed substantially so that approaches which use the ordered nature of functional outcome data (ordinal logistic regression, t-test, robust ranks test, bootstrapping the difference in mean rank) were more efficient statistically than those which collapse the data into 2 groups (chi square) (ANOVA p<0.001). The findings were consistent across different types and sizes of trial and for the different measures of functional outcome. Conclusions: When analysing functional outcome from stroke trials, statistical tests which use the original ordered data are more efficient and more likely to yield reliable results. Suitable approaches included ordinal logistic regression, t-test, and robust ranks test.

The revolving door of mental, neurological, and substance use disorders re-hospitalization in rural KwaZulu-Natal Province, South Africa.

Objective: Little is known about the extent of mental, neurological and substance-use (MNS) disorders re-hospitalization in South Africa. We examined the extent of one-year MNS re-hospitalization (MNS-R) in a rural South African primary health care facility (PHCF). Methods: We conducted a retrospective analysis of hospital administrative data from 10,525 adults discharged from a rural PHCF in KwaZulu-Natal Province, South Africa. Chi-squared tests were utilized to describe MNS-R within one year of an index hospital admission in individuals with MNS, with a sub-analysis also being conducted to describe schizophrenia re-hospitalization (S-R). Results: The prevalence of MNS and schizophrenia recorded at an index hospitalization was 5% and 1%, respectively. A total of 44/67 (66%) individuals with a diagnosis of MNS at the index hospitalization were classified as having MNS-R during oneyear follow-up period. Half of those diagnosed with schizophrenia at the index hospitalization (6/12 patients) were classified as having S-R during one-year follow-up period. There was a significant association between re-hospitalization outcomes (MNS-R and S-R) and MNS (p<0.01) or schizophrenia diagnosis (p<0.01) at index baseline hospitalization. Conclusion: The extent of MNS-R and S-R remains relatively high in rural South Africa, and needs further health systems strengthening to prevent revolving door occurrences.

The New Bottom Line: Black Women Cultural Entrepreneurs Re-Define Success in The Connected Economy

Black women cultural entrepreneurs are a group of entrepreneurs that merit further inquiry. Using qualitative interview and participant observation data, this dissertation investigates the ways in which black women cultural entrepreneurs define success. My findings reveal that black women cultural entrepreneurs are a particular interpretive community with values, perspectives and experiences, which are not wholly idiosyncratic, but shaped by collective experiences and larger social forces. Black women are not a monolith, but they are neither disconnected individuals completely devoid of group identity. The meaning they give to their businesses, professional experiences and understandings of success are influenced by their shared social position and identity as black women. For black women cultural entrepreneurs, the New Bottom Line goes beyond financial gain. This group, while not uniform in their understandings of success, largely understand the most meaningful accomplishments they can realize as social impact in the form of cultural intervention, black community uplift and professional/creative agency. These particular considerations represent a new paramount concern, and alternative understanding of what is typically understood as the bottom line. The structural, social and personal challenges that black women cultural entrepreneurs encounter have shaped their particular perspectives on success. I also explore the ways research participants articulated an oppositional consciousness to create an alternative means of defining and achieving success. I argue that this consciousness empowers them with resources, connections and meaning not readily conferred in traditional entrepreneurial settings. In this sense, the personal, social and structural challenges have been foundational to the formation of an alternative economy, which I refer to as The Connected Economy. Leading and participating in The Connected Economy, black women cultural entrepreneurs represent a black feminist and womanist critique of dominant understandings of success.

Resistance performances: (Re)constructing spaces of resistance and contention in the 2010-2011 University of Puerto Rico student movement

On the night of April 20, 2010, a group of students from the University of Puerto Rico (UPR), Río Piedras campus, met to organize an indefinite strike that quickly broadened into a defense of accessible public higher education of excellence as a fundamental right and not a privilege. Although the history of student activism in the UPR can be traced back to the early 1900s, the 2010-2011 strike will be remembered for the student activists’ use of new media technologies as resources that rapidly prompted and aided the numerous protests. ^ This activist research entailed a critical ethnography and a critical discourse analysis (CDA) of traditional and alternative media coverage and treatment during the 2010 -2011 UPR student strike. I examined the use of the 2010-2011 UPR student activists’ resistance performances in constructing local, corporeal, and virtual spaces of resistance and contention during their movement. In particular, I analyzed the different tactics and strategies of resistance or repertoire of collective actions that student activists used (e.g. new media technologies) to frame their collective identities via alternative news media’s (re)presentation of the strike, while juxtaposing the university administration’s counter-resistance performances in counter-framing the student activists’ collective identity via traditional news media representations of the strike. I illustrated how both traditional and alternative media (re)presentations of student activism developed, maintained, and/or modified students activists’ collective identities. ^ As such, the UPR student activism’s success should not be measured by the sum of demands granted, but by the sense of community achieved and the establishment of networks that continue to create resistance and change. These networks add to the debate surrounding Internet activism and its impact on student activism. Ultimately, the results of this study highlight the important role student movements have had in challenging different types of government policies and raising awareness of the importance of an accessible public higher education of excellence.^

The modern state and the re-creation of the indigenous other: The case of the authentic Sami in Sweden and the white man's Indian in the United States of America

The present study comparatively examined the socio-political and economic transformation of the indigenous Sámi in Sweden and the Indian American in the United States of America occurring first as a consequence of colonization and later as a product of interaction with the modern territorial and industrial state, from approximately 1500 to 1900. ^ The first colonial encounters of the Europeans with these autochthonous populations ultimately created an imagery of the exotic Other and of the noble savage. Despite these disparaging representations, the cross-cultural settings in which these interactions took place also produced the hybrid communities and syncretic life that allowed levels of cultural accommodation, autonomous space, and indigenous agency to emerge. By the nineteenth century, however, the modern territorial and industrial state rearranges the dynamics and reaches of power across a redefined territorial sovereign space, consequently, remapping belongingness and identity. In this context, the status of indigenous peoples, as in the case of Sámi and of Indian Americans, began to change at par with industrialization and with modernity. At this point in time, indigenous populations became a hindrance to be dealt with the legal re-codification of Indigenousness into a vacuumed limbo of disenfranchisement. It is, thus, the modern territorial and industrial state that re-creates the exotic into an indigenous Other. ^ The present research showed how the initial interaction between indigenous and Europeans changed with the emergence of the modern state, demonstrating that the nineteenth century, with its fundamental impulses of industrialism and modernity, not only excluded and marginalized indigenous populations because they were considered unfit to join modern society, it also re-conceptualized indigenous identity into a constructed authenticity.^

The EU referendum in Northern Ireland: closing borders, re-opening border debates

The UK decision to leave the European Union (EU) following a referendum in June 2016 fundamentally alters the country's relationship with the EU, with its European neighbours, with the rest of the world and potentially with its own constituent units. It is clear that different parts of the UK will be impacted differently by this decision and by the unfolding exit terms and process. In this context, Northern Ireland is considered to be particularly vulnerable. This article examines the referendum campaign in Northern Ireland by detailing input from the Northern Ireland administration, political parties, civil society and external figures. The article suggests that the overall referendum campaign in Northern Ireland was hamstrung by the opposing positions taken by key political protagonists, particularly Sinn Féin and the Democratic Unionist Party (DUP). This produced a challenging context for the referendum debate in Northern Ireland. The post-referendum period has also been marked by persistent differences in relation to how best to approach specific Northern Ireland issues and challenges. A continued absence of clear positions and a lack of contingency planning underline a poor level of preparedness for future political developments.

The Influence of Accounting Information in the Re-Election of the Mayors in Portugal

The changes recommended by the New Public Management (NPM) in public accounting have given special attention and importance to the evaluation of mayor’s performance by citizens/voters. Thus, this study aims to assess the impact of accounting information on the re-election of Portuguese mayors. Taking the agency theory as a point of departure, we start from the following research question: Does the accounting information disclosed by the municipalities influence the re-election of Portuguese mayors? The research methodology used in this study is the quantitative type, through which a multivariate analysis of data was performed on 308 Portuguese municipalities, in the period 2005-2008, based on the election results of 2009. The results from the binary logistic regression show that some indicators of accounting nature have impact on the re-election of mayors in Portugal, namely, the components of financial accounting and municipal revenues.

Re-imagining the theology of human sexuality in the Methodist Church: the use of narrative in theological methodology

This thesis proposes the development of a narrative methodology in the British Methodist Church. Such a methodology embraces and communicates both felt experience and critical theological thinking, thus producing and presenting a theology that might have a constructive transformative impact on wider society. In chapter one I explore the ways in which the Church speaks in public, identify some of the challenges it faces, and consider four models of engagement. If the Church is to engage in public discourses then I argue that its words need to be relevant and connect with people’s experiences. To ground the thinking I focus on the context of the British Methodist Church and explore how the Church engages in theological reflection through the lens of its thinking on issues of human sexuality. Chapter two reviews how theological reflection is undertaken in the British Methodist Church. I describe how the Methodist Quadrilateral of Scripture, tradition, reason and experience remains a foundational framework for theological reflection within the Methodist Church and consider the impact of institutional processes and the ways in which the Methodist people actually engage with theological thinking. The third and fourth chapters focus on how the British Methodist Church has produced its theology of human sexuality, giving particular attention to the use of personal and sexual stories in this process. I find that whilst there has been a desire to listen to the stories of the Methodist people, there has not been a corresponding interrogation or analysis of their stories so as to enable robust and constructive theological reflection on these experiences. Using resources from Foucauldian approaches to discourse analysis, I critique key statements and the processes involved in their production, offering an analysis of this body of theological thinking and indicating where possibilities for alternative ways of thinking and acting arise. The proposed methodology draws upon resources from social science methodologies, and in chapter five I look at the use of personal experience and relevant strategies of inquiry that prompt reflection on the hermeneutical process and employ narrative approaches in undertaking, analysing and presenting research. The exploration shows that qualitative research methodologies offer resources and methods of inquiry that could help the Church to engage with personal stories in its theological thinking in a robust, interrogative and imaginative way. In chapter six an examination of story and narrative is undertaken, to show how they have been understood as ways of knowing and how they relate to theological inquiry. Whilst acknowledging some of the limitations of narrative, I indicate how it offers constructive possibilities for theological reflection and could be a means for the British Methodist Church to engage in public discourse. This is explored further in chapter seven, which looks in more detail at how the British Methodist Church has used narrative in its theological thinking, and outlines areas requiring further attention in order for a narrative theological methodology to be developed, namely: attention to the question ‘whose experience?’; investigation of issues of power and the dynamics involved in the process of the production of theological thought; how personal stories and experiences are interrogated and how narrative is constructed; and how narrative might be employed within the Methodist Quadrilateral. The final chapter considers the advantages and limitations of such an approach, whether the development of such a method is possible in the Methodist Church today and its potential for helping the Church to engage in public discourse more effectively. I argue that this methodology can provoke new theological insights and enable new ways of being in the world

Between the centre and the margins: Services location, economic (re)structuring and quality of life in metropolitan periurban areas.

This paper aims to discuss the specificities of the role of services in the economic structuring and in the social liveliness and attractiveness of periurban areas. Drawing upon on the result of an empirical work developed in 5 different parishes of Lisbon Metropolitan area, which represent five categories of periurban spaces previously identified, it is analysed the role of services in these “in-between” territories and the way they are important in the spatial economic structuring of these areas and in the quality of life and well-being of their inhabitants and users. A tentative typology for framing the analysis of the role of services on periurban metropolitan spaces is suggested and some policy implications are pointed out.

Studio comparativo di analisi speditive con metodo RE.SIS.TO. e di analisi statiche non lineari eseguite con software 3Muri per la valutazione della fragilità di edifici in muratura nel comune di Maranello (MO)

L’obiettivo della tesi è stato quello di valutare la vulnerabilità sismica di edifici ordinari in muratura tipici del costruito del Comune di Maranello (MO), e di stimare le curve di fragilità. Vengono individuate le tipologie strutturali in muratura tipiche degli edifici del Comune, che viene suddiviso in comparti secondo il metodo CARTIS. Lo scopo è stato di definire quali sono le tipologie in muratura più vulnerabili, e quindi i comparti del Comune costituiti dagli edifici in muratura più fragili dal punto di vista sismico. La valutazione della vulnerabilità sismica di alcuni edifici rappresentativi delle tipologie murarie esistenti nel territorio analizzato è stata eseguita mediante due metodologie: la prima è una metodologia speditiva chiamata RE.SIS.TO., una valutazione semplificata sviluppata dall’Università degli Studi di Bologna, con l’obiettivo di definire lo stato di criticità degli edifici e di definire la priorità di intervento in tempi brevi; la seconda è una metodologia di valutazione più accurata eseguita attraverso l’analisi statica non lineare con il software 3Muri, un programma per il calcolo sismico delle strutture in muratura.

I solai in legno. Recupero e rifunzionalizzazione di un fabbricato presso il Centro Spirituale di Marola (RE)

L'oggetto della tesi riguarda lo studio dei solai in legno esistenti, inizialmente dal punto di vista teorico, affrontando esempi e problematiche strutturali relative a tale tecnologia. Successivamente si è affrontato lo studio di un fabbricato, attualmente inutilizzato e con i solai e copertura in un pessimo stato di conservazione. Il progetto riguarda un edificio sito a Marola, piccolo comune dell’appennino reggiano. Il fabbricato denominato “Casa del Contadino” fa parte del complesso del Centro Diocesano di Spiritualità e Cultura di Marola. La proposta di progetto riguarda la realizzazione di aule didattiche e di un museo etnografico nel complesso “Casa del contadino” per offrire più opportunità ai turisti religiosi e non che sono ospiti del seminario. Si è partito da un accurato studio sullo stato di fatto dell’edificio, mediante un dettagliato rilievo geometrico e strutturale. Da questo punto di partenza sono in iniziate le ipotesi di intervento, valutando le carenze strutturali del fabbricato e avendo in mente le destinazioni d’uso finali, già descritte sopra. Si sono quindi studiati i dettagli costruttivi relativi all’intervento di consolidamento della copertura lignea, dei solai lignei, sul paramento murario e infine alcune ipotesi di consolidamento delle fondazioni. Di pari passo al disegno tecnico e progettuale, sono stati portati avanti anche calcoli statici riguardanti dimensionamento e verifica della copertura, dei solai e dei principali paramenti murari, che definiscono a livello numerico le strategie d’intervento per un futuro studio diagnostico accurato della struttura.

Efficientamento dei flussi logistici e re-layout del magazzino in ottica lean: il caso SCM group

Con questo elaborato si è analizzata la situazione della Logistica di Produzione allo stato AS IS, dalla quale sono emerse una serie di criticità che provocano inefficienze e sprechi in termini di movimentazioni e risorse. A fronte delle criticità riscontrate, per prima cosa è stata eseguita una mappatura per quanto riguarda la modalità di alimentazione dei vari materiali presenti in azienda. Dopo aver definito una serie di criteri standard da seguire, si è proceduto al cambio dei vari codici nella modalità di alimentazione più appropriata ed alla eventuale ricollocazione dei materiali nell’area di magazzino specifica. In seguito, si è passati alla seconda parte delle attività richieste su direttiva aziendale: la mappatura di tutti i codici con due modalità di alimentazione specifiche (chiamate Kanb e Kit) ed il conseguente dimensionamento dei metri lineari necessari per l’eventuale realizzazione di un’area di magazzino ad hoc per questi materiali. In seguito, si è stabilito per ogni codice quale sia la tipologia di contenitore più adatta ad esso e di conseguenza la migliore collocazione nella nuova area di magazzino che verrà realizzata. Infine, si è realizzata una proposta di Layout del magazzino che comprenda anche la nuova area di dedicata alla tipologia di materiali sopra citati. Tutte queste attività sono state realizzate tenendo sempre conto dei principi e dei concetti della Lean Production in merito alla riduzione degli sprechi, in questo caso inerenti alla movimentazione e gestione dei materiali. L’obiettivo che si vuole raggiungere tramite la nuova area di magazzino è l’aumento dell’efficienza per quel che riguarda l’approvvigionamento delle linee produttive.

Bartonella Spp. Bacteremia In Blood Donors From Campinas, Brazil.

Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death. This pathogen can survive for over a month in stored blood. However, its prevalence among blood donors is unknown, and screening of blood supplies for this pathogen is not routinely performed. We investigated Bartonella spp. prevalence in 500 blood donors from Campinas, Brazil, based on a cross-sectional design. Blood samples were inoculated into an enrichment liquid growth medium and sub-inoculated onto blood agar. Liquid culture samples and Gram-negative isolates were tested using a genus specific ITS PCR with amplicons sequenced for species identification. Bartonella henselae and Bartonella quintana antibodies were assayed by indirect immunofluorescence. B. henselae was isolated from six donors (1.2%). Sixteen donors (3.2%) were Bartonella-PCR positive after culture in liquid or on solid media, with 15 donors infected with B. henselae and one donor infected with Bartonella clarridgeiae. Antibodies against B. henselae or B. quintana were found in 16% and 32% of 500 blood donors, respectively. Serology was not associated with infection, with only three of 16 Bartonella-infected subjects seropositive for B. henselae or B. quintana. Bartonella DNA was present in the bloodstream of approximately one out of 30 donors from a major blood bank in South America. Negative serology does not rule out Bartonella spp. infection in healthy subjects. Using a combination of liquid and solid cultures, PCR, and DNA sequencing, this study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors. Our findings support further evaluation of Bartonella spp. transmission which can occur through blood transfusions.

Hemodynamic Changes With Two Lipid Emulsions For Treatment Of Bupivacaine Toxicity In Swines.

To compare the hemodynamic changes following two different lipid emulsion therapies after bupivacaine intoxication in swines. Large White pigs were anesthetized with thiopental, tracheal intubation performed and mechanical ventilation instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg-1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into three groups and received 4 ml.kg-1 of one of the two different lipid emulsion with standard long-chaim triglyceride, or mixture of long and medium-chain triglyceride, or saline solution. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. Both emulsion improved arterial blood pressure mainly increasing vascular resistance since the cardiac index had no significant improvement. On the systemic circulation the hemodynamic results were similar with both lipid emulsions. Both lipid emulsions were efficient and similar options to reverse hypotension in cases of bupivacaine toxicity.