Estimating the Volume of Cerebral Aneurysms: Method Error versus Volume Variation over Time

BackgroundIntegration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm.ObjectiveTo describe patterns of use and in-hospital mortality associated with surgical and endovascular treatments of cerebral aneurysms over the past decade.Materials and methodsThe data are 34 899 hospital discharges with a diagnosis of ruptured or unruptured cerebral aneurysm from 1998 to 2007 identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular coiling and surgical clipping and in-hospital mortality among patients with an aneurysm are examined over a decade by hospital and patient demographic characteristics.ResultsFrom 1998 to 2007, 20 134 discharges with a ruptured aneurysm and 14 765 discharges with an unruptured aneurysm were identified. Over this decade, the number of patients discharged with a ruptured aneurysm was stable while the number discharged with an unruptured aneurysm increased significantly. The use of endovascular coiling increased at least twofold for both groups of patient (p<0.001) with the majority of unruptured aneurysms treated with coiling by 2007. Although whites were more likely than non-whites to undergo coiling versus clipping for a ruptured aneurysm (OR=1.30; 95% CI 1.13 to 1.48) and men with unruptured aneurysms were more likely than women to undergo coiling (OR=1.26; 95% CI 1.13 to 1.40), by 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant. Over time the use of coiling spread from primarily large, teaching hospitals to smaller, non-teaching hospitals.ConclusionsThe majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.

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Patient-reported outcome measures for patients with cerebral aneurysms acquired via social media: data from a large nationwide sample

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011492 ◽

2014 ◽

Vol 8 (1) ◽

pp. 42-46 ◽

Cited By ~ 6

Author(s):

Michael Chen ◽

Erwin Mangubat ◽

Bichun Ouyang

Keyword(s):

Social Media ◽

Cerebral Aneurysm ◽

Outcome Measures ◽

Study Design ◽

Cerebral Aneurysms ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Physical Impairment ◽

Patient Reported ◽

Over Time

BackgroundWith greater survival rates, patient-reported outcome measures (PROMs) among survivors of ruptured cerebral aneurysm should be an increasing concern among neurointerventionalists. Prior studies were limited in scale and generalizability. Our study aims were to (1) evaluate the validity of cerebral aneurysm PROMs obtained from social media; (2) determine the persistence of PROMs over time; and (3) determine what PROMs still exist in those with no physical impairments.MethodsBy engaging national brain aneurysm support groups and using an online questionnaire modeled after the generic EQ-5D instrument, we asked respondents to classify their health in five dimensions including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a 3-point Likert scale.ResultsIn 2 months we received 604 responses from 46 states in the USA. Our cohort of ruptured aneurysm respondents reported PROMs similar to previously published series. Over time, headache and anxiety improved while depression, level of exercise, and return to work remained unchanged. We found that memory worsened after 2 years. Among those without any physical impairment, rates of 20.6%, 14.9%, 12.6%, and 23% were seen for significant headaches, significant memory loss, significant depression, and sense of life being negatively affected, respectively.ConclusionsDespite this novel study design, we obtained results comparable to prior studies. These results suggest that many patients with ruptured cerebral aneurysms, regardless of whether they are >2 years after the event and/or free of physical impairment, struggle with a poor quality of life. The latency, scale, and low cost of this study design may accelerate future cerebral aneurysm PROM research.

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Effectiveness Assessment of an Innovative Ejector Plant for Port Sediment Management

Journal of Marine Science and Engineering ◽

10.3390/jmse9020197 ◽

2021 ◽

Vol 9 (2) ◽

pp. 197

Author(s):

Marco Pellegrini ◽

Arash Aghakhani ◽

Maria Gabriella Gaeta ◽

Renata Archetti ◽

Alessandro Guzzini ◽

...

Keyword(s):

Water Depth ◽

Sea Water ◽

Market Demand ◽

Sustainable Technologies ◽

Volume Variation ◽

Sediment Volume ◽

Before And After ◽

Full Load Operation ◽

Area Of Influence ◽

Over Time

The need to remove deposited material from water basins is common and has been shared by many ports and channels since the earliest settlements along coasts and rivers. Dredging, the most widely used method to remove sediment deposits, is a reliable and wide-spread technology. Nevertheless, dredging is only able to restore the desired water depth but without any kind of impact on the causes of sedimentation and so it cannot guarantee navigability over time. Moreover, dredging operations have relevant environmental and economic issues. Therefore, there is a growing market demand for alternatives to sustainable technologies to dredging able to preserve navigability. This paper aims to evaluate the effectiveness of guaranteeing a minimum water depth over time at the port entrance at Marina of Cervia (Italy), wherein the first industrial scale ejector demo plant has been installed and operated from June 2019. The demo plant was designed to continuously remove the sediment that naturally settles in a certain area through the operation of the ejectors, which are submersible jet pumps. This paper focuses on a three-year analysis of bathymetries realized at the port inlet before and after ejector demo plant installation and correlates the bathymetric data with metocean data (waves and sea water level) collected in the same period. In particular, this paper analyses the relation between sea depth and sediment volume variation at the port inlet with ejector demo plant operation regimes. Results show that in the period from January to April 2020, which was also the period of full load operation of the demo plant, the water depth in the area of influence of the ejectors increased by 0.72 mm/day, while in the whole port inlet area a decrease of 0.95 mm/day was observed. Furthermore, in the same period of operation, the ejector demo plant’s impact on volume variation was estimated in a range of 245–750 m3.

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M1 macrophages are required for murine cerebral aneurysm formation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012911 ◽

2017 ◽

Vol 10 (1) ◽

pp. 93-97 ◽

Cited By ~ 7

Author(s):

Kamil W Nowicki ◽

Koji Hosaka ◽

Frank J Walch ◽

Edward W Scott ◽

Brian L Hoh

Keyword(s):

Cerebral Aneurysm ◽

Macrophage Polarization ◽

Cerebral Aneurysms ◽

M2 Macrophage ◽

Macrophage Phenotype ◽

Aneurysm Formation ◽

Inflammatory Phenotype ◽

M1 Phenotype ◽

Aneurysm Development ◽

Over Time

IntroductionMacrophages and neutrophils have been separately implicated in cerebral aneurysm formation. The interactions between different myeloid subsets and the contributions of macrophage phenotypes in these lesions over time are not known. The purpose of the study was to examine macrophage phenotypic changes in cerebral aneurysms.MethodsWe induced aneurysm formation in C57BL/6 mice and quantified contributions of M1 and M2 macrophages in aneurysm specimens with or without neutrophil blockade. In our aneurysm model, the left common carotid and right renal arteries were ligated, and mice were placed on a hypertensive high fat diet. One week later, stereotactic injection with elastase solution into the basal cisterns was performed. An angiotensin II secreting osmotic pump was implanted. The mice were then treated with anti-CXCL1 antibody or IgG control antibody. Animals were euthanized at 3 days, or 1 or 2 weeks. The circle of Willis was analyzed using immunohistochemistry for M1 and M2 macrophage phenotype contributions.ResultsProinflammatory M1/M2 ratio increased in cerebral aneurysm formation over time, from 0.56 at 3 days to 1.75 at 2 weeks (p<0.0001). In contrast, anti-CXCL1 antibody blockade led to polarization towards an anti-inflammatory phenotype with an M1/M2 ratio of 0.95 at 2 weeks compared with IgG treated mice (p=0.0007).ConclusionsCXCL1 dependent neutrophil inflammation appears to have an important role in macrophage polarization to M1 phenotype in cerebral aneurysm development.

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Clipping as re-treatment strategy after treatment of a cerebral aneurysm with the Woven EndoBridge embolization device: case report

Journal of Neurosurgery ◽

10.3171/2017.10.jns171528 ◽

2019 ◽

Vol 130 (3) ◽

pp. 891-894 ◽

Cited By ~ 3

Author(s):

Gregor Durner ◽

Yigit Özpeynirci ◽

Bernd Schmitz ◽

Christian Rainer Wirtz ◽

Ralph König ◽

...

Keyword(s):

Indocyanine Green Angiography ◽

Cerebral Aneurysms ◽

Artery Aneurysm ◽

Flow Diverter ◽

Anterior Communicating Artery ◽

Woven Endobridge ◽

Web Device ◽

Prior Experiences ◽

Over Time ◽

The Web

Recently, treatment of cerebral aneurysms with the Woven EndoBridge (WEB) device has become an established endovascular strategy. However, over time, neurosurgeons and neuroradiologists will be confronted with the challenge of how to treat aneurysm recanalization. The authors report the case of a 49-year-old woman who underwent re-treatment with clipping after the recanalization of a 4 × 3–mm anterior communicating artery aneurysm that had previously been treated using a 4 × 3 WEB device. In contrast to the authors’ prior experiences with clipping of previously coiled aneurysms, the WEB device was found to have a responsive softness during clip placement, and the aneurysm was more maneuverable. Moreover, evaluation with indocyanine green angiography was easy to perform because of the transparent mesh of the WEB device. No profound scarring or WEB protrusion was noted during surgery, making the procedure easier and less dangerous with regard to additional complications. The authors suggest that re-treatment via clipping should be considered in select cases of aneurysm recurrence after treatment with an intraaneurysmal flow diverter.

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Social transmission bias and the cultural evolution of folk-economic beliefs

Behavioral and Brain Sciences ◽

10.1017/s0140525x18000365 ◽

2018 ◽

Vol 41 ◽

Cited By ~ 3

Author(s):

David Hirshleifer ◽

Siew Hong Teoh

Keyword(s):

Cultural Evolution ◽

Social Transmission ◽

Cognitive Approach ◽

Economic Problems ◽

Economic Attitudes ◽

The Social ◽

Economic Beliefs ◽

Over Time

AbstractEvolved dispositions influence, but do not determine, how people think about economic problems. The evolutionary cognitive approach offers important insights but underweights the social transmission of ideas as a level of explanation. The need for asocialexplanation for the evolution of economic attitudes is evidenced, for example, by immense variations in folk-economic beliefs over time and across individuals.

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Do student perceptions of their dental curriculum change over time?

Journal of Dental Education ◽

10.1002/j.0022-0337.1998.62.11.tb03260.x ◽

1998 ◽

Vol 62 (11) ◽

pp. 934-937 ◽

Cited By ~ 3

Author(s):

NW Berk ◽

JM Close ◽

RJ Weyant

Keyword(s):

Student Perceptions ◽

Curriculum Change ◽

Change Over Time ◽

Dental Curriculum ◽

Over Time

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Articulatory Generalization in Two Word-Medial, Ambisyllabic Contexts

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1903.251 ◽

1988 ◽

Vol 19 (3) ◽

pp. 251-258 ◽

Cited By ~ 5

Author(s):

Virginia I. Wolfe ◽

Suzanne D. Blocker ◽

Norma J. Prater

Keyword(s):

Common View ◽

Perceptual Salience ◽

The Common ◽

Unitary Concept ◽

Over Time

Articulatory generalization of velar cognates /k/, /g/ in two phonologically disordered children was studied over time as a function of sequential word-morpheme position training. Although patterns of contextual acquisition differed, correct responses to the word-medial, inflected context (e.g., "picking," "hugging") occurred earlier and exceeded those to the word-medial, noninflected context (e.g., "bacon," "wagon"). This finding indicates that the common view of the word-medial position as a unitary concept is an oversimplification. Possible explanations for superior generalization to the word-medial, inflected position are discussed in terms of coarticulation, perceptual salience, and the representational integrity of the word.

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Treatment Fidelity Procedures for an Aphasia Intervention Within a Randomized Controlled Trial: Design, Feasibility, and Results

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-cac48-18-0227 ◽

2020 ◽

Vol 29 (1S) ◽

pp. 412-424

Author(s):

Elissa L. Conlon ◽

Emily J. Braun ◽

Edna M. Babbitt ◽

Leora R. Cherney

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Treatment Protocol ◽

Treatment Fidelity ◽

Protocol Adherence ◽

Study Condition ◽

Randomized Controlled ◽

Aphasia Therapy ◽

Percent Accuracy ◽

Over Time

Purpose This study reports on the treatment fidelity procedures implemented during a 5-year randomized controlled trial comparing intensive and distributed comprehensive aphasia therapy. Specifically, the results of 1 treatment, verb network strengthening treatment (VNeST), are examined. Method Eight participants were recruited for each of 7 consecutive cohorts for a total of 56 participants. Participants completed 60 hr of aphasia therapy, including 15 hr of VNeST. Two experienced speech-language pathologists delivered the treatment. To promote treatment fidelity, the study team developed a detailed manual of procedures and fidelity checklists, completed role plays to standardize treatment administration, and video-recorded all treatment sessions for review. To assess protocol adherence during treatment delivery, trained research assistants not involved in the treatment reviewed video recordings of a subset of randomly selected VNeST treatment sessions and completed the fidelity checklists. This process was completed for 32 participants representing 2 early cohorts and 2 later cohorts, which allowed for measurement of protocol adherence over time. Percent accuracy of protocol adherence was calculated across clinicians, cohorts, and study condition (intensive vs. distributed therapy). Results The fidelity procedures were sufficient to promote and verify a high level of adherence to the treatment protocol across clinicians, cohorts, and study condition. Conclusion Treatment fidelity strategies and monitoring are feasible when incorporated into the study design. Treatment fidelity monitoring should be completed at regular intervals during the course of a study to ensure that high levels of protocol adherence are maintained over time and across conditions.

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