Stroke severity, early recovery and outcome are each related with clinical classification of stroke: data from the 'Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

Introduction: Baseline severity and clinical stroke syndrome (Oxford Community Stroke Project, OCSP) classification are predictors of outcome in stroke. We used data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST) to assess the relationship between stroke severity, early recovery, outcome and OCSP syndrome. Methods: TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1,484 patients with acute ischaemic stroke. Severity was measured as the Scandinavian Neurological Stroke Scale (SNSS) at baseline and days 4, 7 and 10, and baseline OCSP clinical classification recorded: total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) and posterior circulation infarction (POCI). Recovery was calculated as change in SNSS from baseline at day 4 and 10. The relationship between stroke syndrome and SNSS at days 4 and 10, and outcome (modified Rankin scale at 90 days) were assessed. Results: Stroke severity was significantly different between TACI (most severe) and LACI (mildest) at all four time points (p<0.001), with no difference between PACI and POCI. The largest change in SNSS score occurred between baseline and day 4; improvement was least in TACI (median 2 units), compared to other groups (median 3 units) (p<0.001). If SNSS did not improve by day 4, then early recovery and late functional outcome tended to be limited irrespective of clinical syndrome (SNSS, baseline: 31, day 10: 32; mRS, day 90: 4); patients who recovered early tended to continue to improve and had better functional outcome irrespective of syndrome (SNSS, baseline: 35, day 10: 50; mRS, day 90: 2). Conclusions: Although functional outcome is related to baseline clinical syndrome (best with LACI, worst with TACI), patients who improve early have a more favourable functional outcome, irrespective of their OCSP syndrome. Hence, patients with a TACI syndrome may still achieve a reasonable outcome if early recovery occurs.

Early allergen exposure and atopic eczema

Background The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen. Objectives To extend the exposure–response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants. Methods A total of 593 children (92Æ4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth. Results By age 8 years, 150 (25Æ3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28Æ0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1Æ37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0Æ66 and 0Æ71) even after controlling for confounding factors. Conclusions The lack of any clear exposure–disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.

BLACK SURVIVAL POLITICS: ORGANIZED MOBILIZATION STRATEGIES IN AFRICAN AMERICAN COMMUNITIES TO END THE HIV/AIDS EPIDEMIC

The purpose of this study is to examine organizational patterns of African American activism in response the HIV/AIDS epidemic. Given their political, economic, and social disenfranchisement, African Americans have historically developed protest and survival strategies to respond to the devaluation of their lives, health, and well-being. While Black protest strategies are typically regarded as oppositional and transformative, Black survival strategies have generally been conceptualized as accepting inequality. In the case of HIV/AIDS, African American religious and non-religious organizations were less likely to deploy protest strategies to ensure the survival and well-being of groups most at risk for HIV/AIDS—such as African American gay men and substance abusers. This study employs a multiple qualitative case study analysis of four African American organizations that were among the early mobilizers to respond to HIV/AIDS in Washington D.C. These organizations include two secular or community-based organizations and two Black churches or faith-based organizations. Given the association of HIV/AIDS with sexual sin and social deviance, I postulated that Black community-based organizations would be more responsive to the HIV/AIDS-related needs and interests of African Americans than their religious counterparts. More specifically, I expected that Black churches would be more conservative (i.e. maintain paternalistic heteronormative sexual standards) than the community-based organizations. Yet findings indicate that the Black churches in this study were more similar than different than the community-based organizations in their strategic responses to HIV/AIDS. Both the community-based organizations and Black churches drew upon three main strategies in ways that politicalize the struggle for Black survival—or what I regard as Black survival politics. First, Black survival strategies for HIV/AIDS include coalition building at the intersection of multiple systems of inequality, as well as on the levels of identity and community. Second, Black survival politics include altering aspects of religious norms and practices related to sex and sexuality. Third, Black survival politics relies on the resources of the government to provide HIV/AIDS related programs and initiatives that are, in large part, based on the gains made from collective action.

ABLE-BODIED WOMANHOOD: DISABILITY AND CORPOREALLY EXCLUSIONARY NARRATIVES IN BLACK AND WHITE WOMEN’S RIGHTS DISCOURSES, 1832-1932

This project is a feminist disability rhetorical analysis of US black and white women’s rights movements from 1832-1932. Guided by Disability and Feminist Theory, it works to identify the presence and use of patterns of disability tropes in women’s rights discourses. From Lucretia Coffin Mott to Sojourner Truth, Elizabeth Cady Stanton to Mary Church Terrell, and Charlotte Perkins Gilman to Addie Hunton, this project interrogates the rhetorical work of dominant narratives and lesser known voices in women’s rights discourses. I argue that early black and white women’s rights advocates often utilized and repeated a disability rhetoric that relied on disability metaphor, narrative prosthesis, and corporeally exclusionary narratives in order to construct definitions of womanhood. Their insistence on cognitive ability as a marker of “fitness” and “ability” provided the foundation for rights arguments based on ableist assumptions of autonomy and citizenship. I also argue that this use of disability rhetoric relied on and furthered a pervasive ableist ideology present not only in many of these movements, but in US society. In the process, US black and white women’s rights discourses have continually elided women with disabilities from women’s rights discourses because their bodies (physically, cognitively, and/or psychologically) did not meet the ableist prerequisites set for claiming women’s rights during this time period.

The Issue with Issues Management: An Engagement Approach to Integrate Gender and Emotion into Issues Management

Using sexual assault on college campuses as a context for interrogating issues management, this study offers a normative model for inclusive issues management through an engagement approach that can better account for the gendered and emotional dimensions of issues. Because public relations literature and research have offered little theoretical or practical guidance for how issues managers can most effectively deal with issues such as sexual assault, this study represents a promising step forward. Results for this study were obtained through 32 in-depth interviews with university issues managers, six focus groups with student populations, and approximately 92 hours of participant observation. By focusing on inclusion, this revised model works to have utility for an array of issues that have previously fallen outside of the dominant masculine and rationale spheres that have worked to silence marginalized publics’ experiences. Through adapting previous issues management models to focus on inclusion at the heart of a strategic process, and engagement as the strategy for achieving this, this study offers a framework for ensuring more voices are heard—which enables organizations to more effectively communicate with their publics. Additionally, findings from this research may also help practitioners at different types of organizations develop better, and proactive, communication strategies for handling emotional and gendered issues as to avoid negative media attention and work to change organizational culture.

Prevalence of preterm labor in Iran: A systematic review and meta-analysis

Background: Preterm labor, which defines as live-birth delivery before 37 weeks of gestation is a main determinant of neonatal morbidity and mortality around the world. Objective: The aim of this study was to determine the prevalence of preterm labor in Iran by a meta-analysis study, to be as a final measure for policy makers in this field. Materials and Methods: In this meta-analysis, the databases of Thomson database (Web of Knowledge), PubMed/Medline, Science Direct, Scopus, Google Scholar, Iranmedex, Scientific Information Database (SID), Magiran, and Medlib were searched for articles in English and Persian language published between 1995 and 2014. Among the studies with regard to the inclusion and exclusion criteria, 14 studies (out of 1370 publications) were selected. Data were analyzed by using Stata software version 11. The heterogeneity of reported prevalence among studies was evaluated by the Chi-square based Q test and I2 statistics. Results: The results of Chi-square based on Q test and I2 statistics revealed severe heterogeneity (Q=2505.12, p-value < 0.001 and I2= 99.5%) and consequently, the random effect model was used for the meta-analysis. Based on the random effect model, the overall estimated prevalence of preterm in Iran was 9.2% (95% CI: 7.6 – 10.7). Conclusion: Present study summarized the results of previous studies and provided a comprehensive view about the preterm delivery in Iran. In order to achieve a more desirable level and its reduction in the coming years, identifying affecting factor and interventional and preventive actions seem necessary.

Use of weekly assessment data to enhance evaluation of a subjective wellbeing intervention

PURPOSE: While intervention effects in target outcomes have typically been tested based on change from baseline to post-intervention, such approaches typically ignore individual differences in change, including time taken to see improvement. The present study demonstrates how weekly patient-reported data may be used to augment traditional pre-post intervention evaluations in order to gain greater insights into treatment efficacy. METHODS: Two hundred and fifty-two adolescent boys and girls (M age = 13.6 years, SD = 0.6 years) from four secondary schools in Victoria, Australia, were assigned by school into control (n = 88) or intervention (n = 164) groups. The intervention group participated in a 6-week course designed to improve subjective wellbeing (SWB) by fostering resilience, coping skills, and self-esteem. In addition to baseline, post-intervention, and 3-month follow-up assessments of SWB, intervention group participants also completed weekly summarise of affective experiences for the duration of the intervention phase. RESULTS: While standard pre-post data showed significant improvement in SWB for the intervention group relative to controls, weekly data showed individual differences in the trajectory of change during this intervention phase; low SWB individuals experienced initial worsening of symptoms followed by improvement in the second half of the intervention phase, whereas high SWB individuals experienced initial gains, followed by a plateau from Week 4 onwards. CONCLUSIONS: Addition of weekly data provided greater insights into intervention effects by: (1) contradicting the notion that early responsiveness to treatment is predictive of level of improvement by post-intervention, and (2) providing data-based insights into ways to enhance the intervention.

Early childhood science exploration: a vehicle for inclusive practices

Social justice and equity are important elements of all educational services and particularly in early childhood where there is an emphasis on including all children in the everyday life of early childhood settings. This emphasis has targeted both the policies and practices in early childhood to meet the needs of a diverse range of learners. An outcome of policy reform is the emphasis on inclusive education that is based on the right of all children to access and participate in general education. A critical pedagogy approach counters discrimination by promoting positive attitudes towards diversity. Science learning is important for all children as it is an approach to thinking and behaving that incorporates aspects of motor, behavioural, sensory, communication and mental functioning. Children from diverse situations can contribute at their own level to the opportunities involved in exploration and investigations. This paper discusses inclusive pedagogy and planning in early childhood centres with a particular focus on science learning through play and child-instigated explorations.

Precarious decencies: negotiating creative (im)mortalities, in life, together

This paper takes up the question of what might hinder the collaborative impulse among artists and specifically poets, and offers—as one possible answer—the complication posed by the urge of an artist for immortality, or for their (individual) name to live on. The paper begins by returning to a moment in Plato, namely that of the Symposium and its observations concerning the connection between poiesis (making) and a questing after immortality. Contrasting with what seems like Plato's broadly positive framing, the paper takes up a second reading of immortality (or the 'will-to-live') found in an early text of the Yogic canon, that of Patanjali's Yoga Sutras. In this second text, written somewhat later than Plato's, the will-to-live is framed otherwise, as one of five afflictions that can be 'made thin' by practice. The paper's wager is that, viewed in this way, as an affliction, the will-to-live (or urge for immortality) deserves consideration as a hindrance to the impulse towards collaboration. Noting, however, that in the poiesis of writing poetry, where there is both the making of things and the action of making things, this creative constellation always contains the tempering solution to its own inherent lures. Writing, although providing fuel for immortal appetites (due to what it makes), also works to temper the worst of this same impulse via the contribution of practice—as dedication, craft and community-as-practice. The practice of writing, therefore, is already at play, and can be emphasised explicitly for any poet or maker who also wants to be able to want to collaborate. The practice of writing, then, and its turn away from investments in identity, works to thin out the more destructive face of an urge for a dubious eternity that can eclipse our ability to work together creatively with others in this life.

When the virtual influences reality. The conservation project of the toledo gate in ciudad real (Spain)

The Toledo Gate of Ciudad Real, Spain, constructed between the late 13th and early 14th centuries, is the last remaining portion of a once complete medieval city wall. It represents the long history of the city and constitutes its main heritage symbol, dividing the historic city centre from the later 19th and 20th century expansions. In October 2012, the Town Hall and the Montemadrid Foundation started the conservation works to preserve this important monument. The preliminary phase of this project included an in-depth series of scientific studies which were carried out by a multidisciplinary team focusing on archival research, historic investigations, archaeological excavations as well as material composition analysis and main treatment application tests. As a result of these studies a series of virtual 3D models were created to inform, discuss and study the monument. A first digital model permitted visualization of the gate in the 19th century and how the main entrance to the city was integrated as a fundamental part of the city walls. This virtual reconstruction also became an important part of the campaign to raise awareness among the citizens towards a monument that had remained in the shadows for the last century, isolated in a roundabout after the systematic demolition of the city walls in the late 19th century. Over the last three years and as a result of these archaeological and historic investigations and subsequent virtual models, surprisingly new and interesting data were brought to light thus permitting the establishment and corroboration of a new and updated hypothesis of the Toledo Gate that goes beyond the previous ideas. As a result of these studies a new architectural typology with construction techniques of has been suggested. This paper describes how the results of this continuous and interdisciplinary documentation process have benefitted from a computer graphic reconstruction of the gate. It highlights how virtual reconstruction can be a powerful tool for conservation decision making and awareness raising. Furthermore, the interesting results of the final reconstruction hypothesis convinced the technical team responsible for the conservation to alter some aspects of the final project physical interventions in order to focus on some of the features and conclusions discovered through the virtual model study.