Subarachnoid hemorrhage of unknown origin: prognosis and prognostic factors

1985 ◽  
Vol 63 (3) ◽  
pp. 349-354 ◽  
Author(s):  
Jan Brismar ◽  
Göran Sundbärg
Keyword(s):  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Prognostic Significance ◽  
Delayed Cerebral Ischemia ◽  
Content Type ◽  
Full Activity ◽  
Time Work ◽  
Part Time ◽  
Part Time Work ◽  
Fine Print

✓ The cases of 127 consecutive patients with subarachnoid hemorrhage (SAH), in whom cerebral panangiography revealed no cause for the bleeding nor any sign of an intraparenchymatous hemorrhage, were reviewed in a study of the long-term prognosis and the possible prognostic factors in this condition. Data for all 127 patients in the study were obtained, with an average follow-up period of 5.4 years. After the 1st week post-SAH, only three rebleeds had occurred. In all, 80% of the patients had returned to full activity, 91% to at least part-time work; if the patients with hypertension were excluded, these figures rose to 86% and 95%, respectively. Decreased wakefulness on admission related to a slightly poorer prognosis, whereas age and red blood cell count in the cerebrospinal fluid had no prognostic significance. Of those patients who, at the end of the 2nd week following the SAH, were fully awake and had not developed any symptoms of delayed cerebral ischemia (87% of all patients admitted), 88% returned to full activity, 97% to at least part-time work. The survival rate for this group, as well as causes of death, seem to be within the range for normal individuals. It should thus be possible to inform these patients (at least the normotensive ones) of the benignity of their condition, directly after normal angiography. Even among the patients who were able to return to full activity, symptoms attributable to the SAH were common: 22% experienced problems such as frequent headaches, vertigo, irritability, and increased fatigability.

Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage

2000 ◽  
Vol 93 (5) ◽  
pp. 808-814 ◽  
Author(s):  
Mette K. Schulz ◽  
Lars Peter Wang ◽  
Mogens Tange ◽  
Per Bjerre
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Delayed Cerebral Ischemia ◽  
Neuronal Injury ◽  
Low Flow ◽  
Cerebral Microdialysis ◽  
Intracerebral Microdialysis ◽  
Content Type ◽  
Wide Range ◽  
Fine Print

Object. The success of treatment for delayed cerebral ischemia is time dependent, and neuronal monitoring methods that can detect early subclinical levels of cerebral ischemia may improve overall treatment results. Cerebral microdialysis may represent such a method. The authors' goal was to characterize patterns of markers of energy metabolism (glucose, pyruvate, and lactate) and neuronal injury (glutamate and glycerol) in patients with subarachnoid hemorrhage (SAH), in whom ischemia was or was not suspected.Methods. By using low-flow intracerebral microdialysis monitoring, central nervous system extracellular fluid concentrations of glucose, pyruvate, lactate, glutamate, and glycerol were determined in 46 patients suffering from poor-grade SAH. The results in two subgroups were analyzed: those patients with no clinical or radiological signs of cerebral ischemia (14 patients) and those who succumbed to brain death (five patients).Significantly lower levels of energy substrates and significantly higher levels of lactate and neuronal injury markers were observed in patients with severe and complete ischemia when compared with patients without symptoms of ischemia (glucose 0 compared with 2.12 ± 0.15 mmol/L; pyruvate 0 compared with 151 ± 11.5 µmol; lactate 6.57 ± 1.07 compared with 3.06 ± 0.32 mmol/L; glycerol 639 ± 91 compared with 81.6 ± 12.4 µmol; and glutamate 339 ± 53.4 compared with 14 ± 3.33 µmol). Immediately after catheter placement, glutamate concentrations declined over the first 4 to 6 hours to reach stable values. The remaining parameters exhibited stable values after 1 to 2 hours.Conclusions. The results confirm that intracerebral microdialysis monitoring of patients with SAH can be used to detect patterns of cerebral ischemia. The wide range from normal to severe ischemic values calls for additional studies to characterize further incomplete and possible subclinical levels of ischemia.

In the beginning …

2010 ◽  
Vol 23 (4) ◽  
pp. 222-226
Author(s):  
Stephanie Walker
Keyword(s):  
Professional Development ◽  
Design Methodology ◽  
Job Market ◽  
Content Type ◽  
Appropriate Behavior ◽  
Professional Career ◽  
Time Work ◽  
Part Time ◽  
In The Beginning ◽  
Part Time Work

PurposeThe purpose of this paper is to present a first installment of a new column on human resource matters in libraries. It aims to focus on the beginning of a professional career in libraries.Design/methodology/approachThe paper looks at beginning a professional career in libraries, including exhibiting appropriate behavior and caution on professional discussion lists, understanding the realities of a difficult job market and utilizing opportunities for part‐time work and for professional development, highlighting exceptional attributes on a résumé, and doing research on hiring institutions.FindingsThe paper reveals advice for beginning a career in libraries.Originality/valueThe paper provides useful information for those who want to pursue a career as a librarian.

Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?

1996 ◽  
Vol 85 (3) ◽  
pp. 410-418 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Neal F. Kassell ◽  
Teresa P. Germanson ◽  
Gail L. Kongable ◽  
Laura L. Truskowski ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Age Groups ◽  
Age Group ◽  
Content Type ◽  
Poor Outcome ◽  
Symptomatic Vasospasm ◽  
Age Related ◽  
Increased Risk ◽  
Fine Print

✓ Advanced age is a recognized prognostic indicator of poor outcome after subarachnoid hemorrhage (SAH). The relationship of age to other prognostic factors and outcome was evaluated using data from the multicenter randomized trial of nicardipine in SAH conducted in 21 neurosurgical centers in North America. Among the 906 patients who were studied, five different age groups were considered: 40 years or less, 41 to 50, 51 to 60, 61 to 70, and more than 71 years. Twenty-three percent of the individuals enrolled were older than 60 years of age. Women outnumbered men in all age groups. Level of consciousness (p = 0.0002) and World Federation of Neurological Surgeons grade (p = 0.0001) at admission worsened with advancing age. Age was also related to the presence of a thick subarachnoid clot (p = 0.0001), intraventricular hemorrhage (p = 0.0003), and hydrocephalus (p = 0.0001) on an admission computerized tomography scan. The rebleeding rate increased from 4.5% in the youngest age group to 16.4% in patients more than 70 years of age (p = 0.002). As expected, preexisting medical conditions, such as diabetes (p = 0.028), hypertension (p = 0.0001), and pulmonary (p = 0.0084), myocardial (p = 0.0001), and cerebrovascular diseases (p = 0.0001), were positively associated with age. There were no age-related differences in the day of admission following SAH, timing of the surgery and/or location, and size (small vs. large) of the ruptured aneurysm. During the treatment period, the incidence of severe complications (that is, those complications considered life threatening by the reporting investigator) increased with advancing age, occurring in 28%, 33%, 36%, 40%, and 46% of the patients in each advancing age group, respectively (p = 0.0002). No differences were observed in the reported frequency of surgical complications. No age-related differences were found in the overall incidence of angiographic vasospasm; however, symptomatic vasospasm was more frequently reported in the older age groups (p = 0.01). Overall outcome, assessed using the Glasgow Outcome Scale at 3 months post-SAH, was poorer with advancing age (p < 0.001). Multivariate analysis of overall outcome, adjusting for the different prognostic factors, did not remove the age effect, which suggests that the aging brain has a less optimal response to the initial bleeding. Age as a risk factor is a continuum; however, there seems to be a significant increased risk of poor outcome after the age of 60 years.

The influence of part-time work on graduates' careers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Carl Evans ◽  
Ceri Vaughan
Keyword(s):  
Career Aspirations ◽  
University Teaching ◽  
Small Element ◽  
Structured Interviews ◽  
Content Type ◽  
Time Work ◽  
Part Time ◽  
Personal Skills ◽  
Part Time Work

PurposeThe purpose of this paper is to explore university students' perceptions about career development in relation to their part-time working and to examine whether students maximise opportunities arising in their part-time job in order to enhance their personal profile and career aspirations.Design/methodology/approachSemi-structured interviews were held with 20 degree students at a UK university. The interview was based around 19 questions, split into three sections: general; career and the part-time job.FindingsThe findings indicate that while students are aware that part-time work helps in developing personal skills, there is a lack of awareness on how part-time work can provide differentiation in the graduate jobs market and support long-term graduate careers. The conclusion discusses the implications of the findings suggesting greater awareness among students of how part-time work can drive work readiness and long-term career aspirations. It also recommends greater involvement of career advisors and university teaching colleagues in supporting this endeavour.Originality/valueWhile other papers on student working have included a small element regarding careers, this paper offers originality by focussing solely on the relationship between students' part-time work and career aspirations. Moreover, most works in this area have been quantitative studies, whereas this study is qualitatively-based.

Cerebral hemodynamic impairment after aneurysmal subarachnoid hemorrhage as evaluated using transcranial Doppler ultrasonography: relationship to delayed cerebral ischemia and clinical outcome

2001 ◽  
Vol 95 (3) ◽  
pp. 393-401 ◽  
Author(s):  
Tõnu Rätsep ◽  
Toomas Asser
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Clinical Outcome ◽  
Transcranial Doppler ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Content Type ◽  
Unfavorable Clinical Outcome ◽  
Hemodynamic Impairment ◽  
Fine Print

Object. In this study the authors evaluated the relative role of cerebral hemodynamic impairment (HDI) in the pathogenesis of delayed cerebral ischemia and poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). Methods. Cerebral hemodynamics were assessed daily with transcranial Doppler (TCD) ultrasonography in 55 consecutive patients with verified SAH. Hemodynamic impairment was defined as blood flow velocity (BFV) values consistent with vasospasm in conjunction with impaired autoregulatory vasodilation as evaluated using the transient hyperemic response tests in the middle cerebral arteries. A total of 1344 TCD examinations were performed, in which the evaluation of HDI was feasible during 80.9% and HDI was registered during 12% of the examinations. It was found that HDI occurred in 60% of patients and was frequently recorded in conjunction with severe vasospasm (p < 0.05) and a rapid increase of BFV values (p < 0.05). Detection of HDI was closely associated with the development of delayed ischemic brain damage after SAH (p < 0.05). Furthermore, because delayed ischemia was never observed in cases in which vasospasm had not led to the development of HDI, its occurrence increased significantly the likelihood of subsequent cerebral ischemia among the patients with vasospasm (p < 0.05). Detection of HDI was independently related to unfavorable clinical outcome according to Glasgow Outcome Scale at 6 months after SAH (p < 0.05). Conclusions. The results showed that HDI is common after SAH and can be evaluated with TCD ultrasonography in routine clinical practice. Detection of HDI could be useful for identifying patients at high or low risk for delayed ischemic complications and unfavorable clinical outcome after SAH.

scholarly journals Understanding self-efficacy and the dynamics of part-time work and career aspiration

2019 ◽  
Vol 9 (3) ◽  
pp. 468-484
Author(s):  
Gbolahan Gbadamosi ◽  
Carl Evans ◽  
Mark Richardson ◽  
Yos Chanthana
Keyword(s):  
Higher Education ◽  
Curriculum Design ◽  
Self Efficacy ◽  
Career Aspirations ◽  
East Asian Country ◽  
Full Time ◽  
Content Type ◽  
Time Work ◽  
Part Time ◽  
Part Time Work

PurposeBuilding on the self-efficacy theory and self-theories, the purpose of this paper is to investigate students working part-time whilst pursuing full-time higher education in Cambodia. It explores individuals’ part-time working activities, career aspirations and self-efficacy.Design/methodology/approachData were collected in a cross-sectional survey of 850 business and social sciences degree students, with 199 (23.4 per cent) usable responses, of which 129 (65.2 per cent of the sample) indicated they currently have a job.FindingsMultiple regression analysis confirmed part-time work as a significant predictor of self-efficacy. There was a positive recognition of the value of part-time work, particularly in informing career aspirations. Female students were significantly more positive about part-time work, demonstrating significantly higher career aspirations than males. Results also suggest that students recognise the value that work experience hold in identifying future career directions and securing the first graduate position.Practical implicationsThere are potential implications for approaches to curriculum design and learning, teaching and assessment for universities. There are also clear opportunities to integrate work-based and work-related learning experience into the curriculum and facilitate greater collaboration between higher education institutions and employers in Cambodia.Social implicationsThere are implications for recruitment practices amongst organisations seeking to maximise the benefits derived from an increasingly highly educated workforce, including skills acquisition and development, and self-efficacy.Originality/valueIt investigates the importance of income derived from part-time working to full-time university students in a developing South-East Asian country (Cambodia), where poverty levels and the need to contribute to family income potentially predominate the decision to work while studying.

Aspirin and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

1995 ◽  
Vol 82 (6) ◽  
pp. 945-952 ◽  
Author(s):  
Seppo Juvela
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Cerebral Infarction ◽  
Platelet Function ◽  
Delayed Cerebral Ischemia ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Reduced Risk ◽  
Fine Print

✓ This follow-up study was designed to evaluate whether the use of aspirin either before or after aneurysm rupture affects the occurrence of delayed cerebral ischemia. Aspirin inhibits platelet function and thromboxane production and has been shown to reduce the risk of various cardiovascular and cerebrovascular ischemic diseases. Following admission, the patients in this study were interviewed regarding their use of aspirin and other medicines prior to and after hemorrhage, and their urine was screened qualitatively for salicylates. Patient outcome and the occurrence of hypodense lesions consistent with cerebral infarction on follow-up computerized tomography (CT) were studied prospectively up to 1 year after hemorrhage. Of 291 patients, 31 (11%) died because of the initial hemorrhage and 18 (6%) died due to rebleeding within 4 days after hemorrhage. Of the remaining 242 patients, 90 (37%) had delayed cerebral ischemia, which caused a permanent neurological deficit or death in 54 patients (22%). Of 195 patients undergoing follow-up CT, 85 (44%) had cerebral infarction that was not seen on the CT scan obtained on admission. Those who had salicylates in the urine on admission had a relative risk of 0.40 (95% confidence interval (CI), 0.15 to 1.10) of delayed ischemia with fixed deficit and a risk of 0.40 (95% CI, 0.18 to 0.93) of cerebral infarction compared with patients who did not have salicylates in their urine. This reduced risk of ischemic complications with aspirin use was restricted to those patients who used aspirin before hemorrhage, when the risk of ischemia was 0.21 (95% CI, 0.03 to 1.63) and the risk of infarct was 0.18 (95% CI, 0.04 to 0.84) compared with those who had not used aspirin. The reduced risk of cerebral infarction remained significant after adjustment for several potential confounding factors (adjusted risk 0.19; 95% CI, 0.04 to 0.89). These observations suggest that platelet function at the time of subarachnoid hemorrhage may be associated with delayed cerebral ischemia after aneurysm rupture.

Part time work, productivity and institutional policies

2015 ◽  
Vol 2 (2) ◽  
pp. 176-200 ◽  
Author(s):  
Christiana Ierodiakonou ◽  
Eleni Stavrou
Keyword(s):  
Work Productivity ◽  
Institutional Context ◽  
Institutional Policies ◽  
Firm Level ◽  
Content Type ◽  
Nonstandard Work ◽  
Time Work ◽  
Part Time ◽  
Employment Legislation ◽  
Part Time Work

Purpose – The purpose of this paper is to develop and empirically test a multilevel framework for examining the links between part time work, productivity and institutional context. The authors emphasize the importance of integrating different theoretical perspectives to enrich the understanding of nonstandard work arrangements such as part time and organizational effectiveness such as productivity. Design/methodology/approach – The authors used data from 2,839 businesses in 21 OECD countries. At the firm level, primary data were collected from the 2008 to 2010 survey of the Cranet research network. At the national level, the authors used information from OECD and Botero et al. (2004). The authors analysed the data using hierarchical linear modelling. Findings – Firm use of part time work relates negatively to employment legislation but positively to gender empowerment. The relationship between part time work and productivity at firm level is moderated by employment legislation. Research limitations/implications – This study provides a basis for research in nonstandard work, firm outcomes and institutional policies to further advance. Practical implications – Results indicate how managers should consider the relevant institutional context when deciding whether to promote the use of part time work. Results also show that policy-makers should be careful since employment policies may have adverse effects on use of part time in specific contexts. Originality/value – The authors make theoretical and empirical contributions to the study of nonstandard arrangements by introducing a framework that better captures the complex interrelations between use of part time work, productivity and institutional context. Theoretically, the authors combine the resource based view with institutional theory into a multilevel framework that challenges the conventional model of the flexible firm.

Under-employment to drive the West's wages and policy

2019 ◽  
Keyword(s):  
Blue Collar ◽  
Full Time ◽  
Job Seekers ◽  
Job Market ◽  
Content Type ◽  
Advanced Economies ◽  
Time Work ◽  
Part Time ◽  
The Impact ◽  
Part Time Work

Subject The impact of working less hours on policy. Significance Part-time work is increasing across the advanced economies, including those working part time but wanting full-time work. Initially this seemed to be a distinctly Japanese problem, but it is now being recognised as a more widespread source of stagnant wages, blue-collar despair and populist politics. Impacts Weak demand since 2008 has allowed more firms to offer fewer hours to desperate job seekers, giving the under-employment trend momentum. Japan has changed its labour laws and broken down norms attached to the content of a job since the 1990s; other countries will follow. Convenience and lower wages drive firms to include under-employed workers in their workforce; only a tighter job market will end this.

scholarly journals Living hours under pressure: flexibility loopholes in the Danish IR-model

2017 ◽  
Vol 39 (6) ◽  
pp. 888-902 ◽  
Author(s):  
Anna Ilsøe ◽  
Trine Pernille Larsen ◽  
Jonas Felbo-Kolding
Keyword(s):  
Working Hours ◽  
Working Time ◽  
Content Type ◽  
Income Levels ◽  
Collective Agreements ◽  
Marginal Part ◽  
Time Work ◽  
Part Time ◽  
Industrial Cleaning ◽  
Part Time Work

Purpose The purpose of this paper is to investigate the effect of part-time work on absolute wages. The empirical focus is wages and working hours in three selected sectors within private services in the Danish labour market – industrial cleaning, retail, hotels and restaurants – and their agreement-based regulation of working time and wages. Theoretically, this analysis is inspired by the concept of living hours, which addresses the interaction between working hours and living wages, but adds a new layer to the concept in that the authors also consider the importance of working time regulations for securing a living wage. Design/methodology/approach The paper builds on desk research of collective agreements and analysis of monthly administrative register data on wages and working hours of Danish employees from the period 2008-2014. Findings This analysis shows that the de facto hourly wages have increased since the global financial crisis in all three sectors. This is in accordance with increasing minimum wage levels in the sector-level agreements. The majority of workers in all three sectors work part-time. Marginal part-timers – 15 hours or less per week – make up the largest group of workers. The de facto hourly wage for part-timers, including marginal part-timers, is relatively close to the sector average. However, the yearly job-related income is much lower for part-time than for full-time workers and much lower than the poverty threshold. Whereas the collective agreement in industrial cleaning includes a minimum floor of 15 weekly working hours – this is not the case in retail, hotels and restaurants. This creates a loophole in the latter two sectors that can be exploited by employers to gain wage flexibility through part-time work. Originality/value The living wage literature usually focusses on hourly wages (including minimum wages via collective agreements or legislation). This analysis demonstrates that studies of low-wage work must include the number of working hours and working time regulations, as this aspect can have a dramatic influence on absolute wages – even in cases of hourly wages at relatively high levels. Part-time work and especially marginal part-time work can be associated with very low yearly income levels – even in cases like Denmark – if regulations do not include minimum working time floors. The authors suggest that future studies include the perspective of living hours to draw attention to the effect of low number of weekly hours on absolute income levels.

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