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Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial registry.
Methods:
Clinical data of all AIS patients who underwent EVT between January 2017 and December 2022 in the province of Saskatchewan were captured in the Canadian OPTIMISE registry and supplemented with patient data from administrative data sources. Patient baseline characteristics, transport time metrics, and technical EVT outcomes between female and male EVT patients were compared.
Results:
Three-hundred-three patients underwent EVT between 2017 and 2022: 144 (47.5%) women and 159 (52.5%) men. Women were significantly older (median age 77.5 [interquartile range: 66–85] vs.71 [59–78], p < 0.001), while men had more intracranial internal carotid artery occlusions (48/159 [30.2%] vs. 26/142 [18.3%], p = 0.03). Last-known-well to comprehensive stroke center (CSC)-arrival time (median 232 min [interquartile range 90–432] in women vs. 230 min [90–352] in men), CSC-arrival-to-reperfusion time (median 108 min [88–149] in women vs. 102 min [77–141] in men), reperfusion status (successful reperfusion 106/142 [74.7%] in women vs. 117/158 [74.1%] in men) as well as modified Rankin score at 90 days did not differ significantly. This held true after adjusting for baseline variables in multivariable analyses.
Conclusion:
While women undergoing EVT in the province of Saskatchewan were on average older than men, they were treated just as fast and achieved similar technical and clinical outcomes compared to men.
The Standard Picture holds that the contribution to the law made by an authoritative legal pronouncement is directly explained by the linguistic content of that pronouncement. This essay defends the Standard Picture from Mark Greenberg’s purported counterexamples drawn from patterns of statutory interpretation in U.S. criminal law. Once relevant features of the U.S. rule of recognition are admitted into the analysis—namely, that it arranges sources of law hierarchically, and that judicial decisions are sources of valid law—Greenberg’s counterexamples are revealed as only apparent, not genuine. The legal norms that result from the patterns of interpretation he identifies can be directly explained in terms of the linguistic contents of authoritative pronouncements: judicial decisions. Furthermore, those norms can be understood as modifications of the valid norms contained in their originating statutes because judicial decisions are permitted ‘explanatory intermediaries’ of statutes by the rule of recognition.
Community-based participatory research (CBPR) is an approach that empowers marginalized groups to become partners in research. However, CBPR can be challenging to implement and has been underutilized in research on substance use disorder (SUD). The goal of this chapter is to provide practical knowledge and resources for individuals who wish to implement CBPR projects related to the stigma of SUD. In this chapter, we define CBPR, apply principles of CBPR to a case example, and suggest ways that community members can be directly involved in research on SUD stigma. We consider how CBPR might address gaps in research on the stigma of SUD and provide guidelines to engaging stakeholders in CBPR. Drawing from the literature on other health stigmatized health conditions, we present issues to consider during implementation of CBPR projects and models that can guide CBPR work.
The Exchequer bills were a key component in Britain's financial revolution of the 1690s. Using a range of archival sources not examined in previous work, this article argues that closer study of how these bills were given credit and circulation between 1696 and 1698 can offer a more nuanced reading of the mechanisms which helped to create credible commitment in this period. Though proper institutional design did help to give the bills credit, it was only one part of a wider series of informal measures used by the Treasury to secure subscribers for the fund for circulating the bills and to manage the emission of bills to prevent high discounts. This reflects the fact that credit and confidence in this period were influenced by a wide range of factors, including commercial advantage, patriotism and the example offered by other investors, all of which could be manipulated by the Treasury to promote the credibility of the Exchequer bills. Proper institutional and financial incentives were therefore not the only factors which could create credible commitment in Britain's financial revolution.
Urban renewal in the British Isles in the long eighteenth century was based on new municipal powers made possible by parliament. Focusing on Jamaica between 1770 and 1805, which passed legislation for the ‘policing’ – in the broader Scottish sense – of its towns, demonstrates that it was a global phenomenon common to the whole British Atlantic. However, the solutions it produced were also specific to local circumstances. Jamaican elites feared invasion, revolt and the dissolution of the slave society. Their police acts reflected these concerns, and demonstrate the alternative pathway that urban modernity took in this part of the British Atlantic.
Between its first meeting in January 1664 and the final session held under unfree labour in December 1838, the volume of legislation passed by the house of assembly in Jamaica increased exponentially. As in Britain and Ireland, this reflected the growing administrative capacity and political power of the legislature and also the enormous demand for laws and law-making among local interest groups. The rise and fall of slavery and the slave society in the island was therefore underpinned in a large part by the power of its colonial legislature, which also operated within the broader transatlantic constitution structured by imperial politics and law. There was very little though to distinguish the house of assembly from others in British North America, at least in legislative terms, and even after the traumatic imperial disjuncture of 1783 the reformed transatlantic constitution continued to provide a supportive environment for the expansion of legislation within the island of Jamaica.
Polarization is a topic of intense interest among social scientists, but there is significant disagreement regarding the character of the phenomenon and little understanding of underlying mechanics. A first problem, we argue, is that polarization appears in the literature as not one concept but many. In the first part of the article, we distinguish nine phenomena that may be considered polarization, with suggestions of appropriate measures for each. In the second part of the article, we apply this analysis to evaluate the types of polarization generated by the three major families of computational models proposing specific mechanisms of opinion polarization.
To examine self-reported practices and policies to reduce infection and transmission of multidrug-resistant organisms (MDRO) in healthcare settings outside the United States.
DESIGN
Cross-sectional survey.
PARTICIPANTS
International members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.
METHODS
Electronic survey of infection control and prevention practices, capabilities, and barriers outside the United States and Canada. Participants were stratified according to their country’s economic development status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-income.
RESULTS
A total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76 respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution. High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64 [61%] vs 25/64 [39%], P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72 [44%], P=.05). Major barriers to preventing MDRO transmission included constrained resources (infrastructure, supplies, and trained staff) and challenges in changing provider behavior.
CONCLUSIONS
In this survey, a substantial proportion of institutions reported encountering barriers to implementing key MDRO prevention strategies. Interventions to address capacity building internationally are urgently needed. Data on the infection prevention practices of low income countries are needed.
Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs.
This article examines a petition drawn up by Robert Ayleway, an official within the Irish fiscal-military state in 1692, in connection with charges of corruption and incompetence during the Williamite Wars (1689–91). Ayleway’s petition, and his wider career, demonstrate that he was part of a process of English and Irish state formation that had begun well before 1688, driven by informal patronage networks as much as by formal bureaucratic developments, creating an entrenched interest group of officials that nevertheless came into conflict after 1689 with new officers, many of them foreign, who came to Ireland in William III’s train. Both sides suspected the loyalty of the other, but the petition reveals that Ayleway saw himself, with some justice, as a competent and loyal official who had used his private means to serve the public in a way that had also advanced his own private interests, suggesting something of the ethos of officials within the new Irish (and English) fiscal-military state.
Work on the ‘county community’ during the English Civil War, and tensions between centre and periphery, has focused exclusively upon forms of political and cultural representation. However, this article argues that local communities also sought to achieve agency within the wider war effort by lobbying for military representation. In return for financial contributions, supporters wanted an ‘interest’ in the units they raised, mainly through control over the nomination of officers. The history of the army of the earl of Essex between June and December 1642 indicates the financial consequences of neglecting such military representation. Its structure dissolved particularist interests, orientating the army towards the pursuit of a national strategy, but this gave local supporters no confidence that their concerns were being represented. The result was an assertion of localism, a decline in donations, and a financial crisis within the army.
It is shown that the relativistic Vlasov–Maxwell equations admit a solution very much like the transverse Alfvén wave of magnetohydrodynamic theory. This wave propagates as a plane electromagnetic wave of arbitrary amplitude, is noncompressive, is associated with fluctuations in direction (but not magnitude) of magnetic field, is characterized by a non-linear ‘dispersion relation’, and reduces in the limit of small amplitude to the transverse Alfvén mode of linearized plasma wave theory. The dispersion relation yields a criterion for the firehose instability which turns out to be the same as that derived from linearized theory.