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  • 1
    Online Resource
    Online Resource
    Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials
    SAGE Publications ; 2017
    In:  International Journal of Stroke Vol. 12, No. 7 ( 2017-10), p. 770-778
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 12, No. 7 ( 2017-10), p. 770-778
    Abstract: Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus intensive medical therapy versus intensive medical therapy alone. The risk factor targets of centrally directed intensive medical therapy are LDL cholesterol 〈 70 mg/dl and systolic blood pressure 〈 140 mmHg. Study outcomes The primary outcome is the composite of stroke and death within 44 days following randomization and stroke ipsilateral to the target vessel thereafter, up to four years. Change in cognition and differences in major and minor stroke are secondary outcomes. Sample size Enrollment of 1240 patients in each trial provides 85% power to detect a treatment difference if the event rate in the intensive medical therapy alone arm is 4.8% higher or 2.8% lower than an anticipated 3.6% rate in the revascularization arm. Discussion Management of asymptomatic carotid stenosis requires contemporary randomized trials to address whether carotid endarterectomy or carotid stenting plus intensive medical therapy is superior in preventing stroke beyond intensive medical therapy alone. Whether carotid endarterectomy or carotid stenting has favorable effects on cognition will also be tested. Trial registration United States National Institutes of Health Clinicaltrials.gov NCT02089217
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493017706238
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2211666-7
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  • 2
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    Online Resource
    Vitamin D deficiency and incident stroke risk in community-living black and white adults
    SAGE Publications ; 2016
    In:  International Journal of Stroke Vol. 11, No. 1 ( 2016-01), p. 93-102
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 11, No. 1 ( 2016-01), p. 93-102
    Abstract: Black individuals are at greater risk of stroke and vitamin D deficiency than white individuals. Epidemiologic studies have shown that low 25-hydroxyvitamin D concentrations are associated with increased risk of stroke, but these studies had limited representation of black individuals. Methods We examined the association of 25-hydroxyvitamin D with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults ≥45 years of age. Using a case–cohort study design, plasma 25-hydroxyvitamin D was measured in 610 participants who developed incident stroke (cases) and in 937 stroke-free individuals from a stratified cohort random sample of REGARDS participants (comparison cohort). Results In multivariable models adjusted for socio-demographic factors, co-morbidities and laboratory values including parathyroid hormone, lower 25-hydroxyvitamin D concentrations were associated with higher risk of stroke (25-hydroxyvitamin D 〉 30 ng/mL reference; 25-hydroxyvitamin D concentrations 20–30 ng/mL, hazard ratio 1.33, 95% confidence interval (95% CI) 0.89,1.96; 25-hydroxyvitamin D 〈 20 ng/mL, hazard ratio 1.85, 95% CI 1.17, 2.93). There were no statistically significant differences in the association of lower 25-hydroxyvitamin D with higher risk of stroke in black vs. white participants in fully adjusted models (hazard ratio comparing lowest vs. highest 25-hydroxyvitamin D category 2.62, 95% CI 1.18, 5.83 in blacks vs. 1.64, 95% CI 0.83, 3.24 in whites, P interaction  = 0.82). The associations were qualitatively unchanged when restricted to ischemic or hemorrhagic stroke subtypes or when using race-specific cut-offs for 25-hydroxyvitamin D categories. Conclusions Vitamin D deficiency is a risk factor for incident stroke and the strength of this association does not appear to differ by race.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493015607515
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2211666-7
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  • 3
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    Online Resource
    Speed-of-Processing and Driving Simulator Training Result in Improved Driving Performance
    SAGE Publications ; 2003
    In:  Human Factors: The Journal of the Human Factors and Ergonomics Society Vol. 45, No. 2 ( 2003-06), p. 218-233
    Details
    In: Human Factors: The Journal of the Human Factors and Ergonomics Society, SAGE Publications, Vol. 45, No. 2 ( 2003-06), p. 218-233
    Abstract: Useful field of view, a measure of processing speed and spatial attention, can be improved with training. We evaluated the effects of this improvement on older adults' driving performance. Elderly adults participated in a speed-of-processing training program ( N = 48), a traditional driver training program performed in a driving simulator ( N = 22), or a low-risk reference group ( N = 25). Before training, immediately after training or an equivalent time delay, and after an 18-month delay each participant was evaluated in a driving simulator and completed a 14-mile (22.5-km) open-road driving evaluation. Speed-of-processing training, but not simulator training, improved a specific measure of useful field of view (UFOV®), transferred to some simulator measures, and resulted in fewer dangerous maneuvers during the driving evaluation. The simulator-trained group improved on two driving performance measures: turning into the correct lane and proper signal use. Similar effects were not observed in the speed-of-processing training or low-risk reference groups. The persistence of these effects over an 18-month test interval was also evaluated. Actual or potential applications of this research include driver assessment and/or training programs and cognitive intervention programs for older adults.
    Type of Medium: Online Resource
    ISSN: 0018-7208 , 1547-8181
    URL: Article
    DOI: 10.1518/hfes.45.2.218.27241
    RVK:
    CL 1000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
    detail.hit.zdb_id: 2066426-6
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  • 4
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    Online Resource
    Mild Cognitive Impairment and Everyday Function: An Investigation of Driving Performance
    SAGE Publications ; 2009
    In:  Journal of Geriatric Psychiatry and Neurology Vol. 22, No. 2 ( 2009-06), p. 87-94
    Details
    In: Journal of Geriatric Psychiatry and Neurology, SAGE Publications, Vol. 22, No. 2 ( 2009-06), p. 87-94
    Abstract: Mild Cognitive Impairment (MCI) involves subtle functional losses that may include decrements in driving skills. We compared 46 participants with MCI to 59 cognitively normal controls on a driving evaluation conducted by a driving rehabilitation specialist who was blinded to participants' MCI classification. Participants with MCI demonstrated significantly lower performance than controls on ratings of global and discrete driving maneuvers, but these differences were not at the level of frank impairments. Rather, performance was simply less than optimal, which to a lesser degree was also characteristic of a subset of the cognitively normal control group. The finding of significantly lower global driving ratings, coupled with the increased incidence of dementia among people with MCI and the known impact of dementia on driving safety, suggests the need for increased vigilance among clinicians, family members, and individuals with MCI for initially benign changes in driving that may become increasingly problematic over time.
    Type of Medium: Online Resource
    ISSN: 0891-9887 , 1552-5708
    URL: Article
    DOI: 10.1177/0891988708328215
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2094096-8
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  • 5
    Online Resource
    Online Resource
    Lower Hippocampal Volume Predicts Decrements in Lane Control Among Drivers With Amnestic Mild Cognitive Impairment
    SAGE Publications ; 2013
    In:  Journal of Geriatric Psychiatry and Neurology Vol. 26, No. 4 ( 2013-12), p. 259-266
    Details
    In: Journal of Geriatric Psychiatry and Neurology, SAGE Publications, Vol. 26, No. 4 ( 2013-12), p. 259-266
    Abstract: There are few methods to discern driving risks in patients with early dementia and mild cognitive impairment (MCI). We aimed to determine whether structural magnetic resonance imaging (MRI) of the hippocampus—a biomarker of probable Alzheimer pathology and a measure of disease severity in those affected—is linked to objective ratings of on-road driving performance in older adults with and without amnestic MCI. Methods: In all, 49 consensus-diagnosed participants from an Alzheimer’s Disease Research Center (15 diagnosed with amnestic MCI and 34 demographically similar controls) underwent structural MRI and on-road driving assessments. Results: Mild atrophy of the left hippocampus was associated with less-than-optimal ratings in lane control but not with other discrete driving skills. Decrements in left hippocampal volume conferred higher risk for less-than-optimal lane control ratings in the patients with MCI (B = −1.63, standard error [SE] = .74, Wald = 4.85, P = .028), but not in controls (B = 0.13, SE = .415, Wald = 0.10, P = .752). The odds ratio and 95% confidence interval for below-optimal lane control in the MCI group was 4.41 (1.18-16.36), which was attenuated to 3.46 (0.88-13.60) after accounting for the contribution of left hippocampal volume. Conclusion: These findings suggest that there may be a link between hippocampal atrophy and difficulties with lane control in persons with amnestic MCI. Further study appears warranted to better discern patterns of brain atrophy in MCI and Alzheimer disease and whether these could be early markers of clinically meaningful driving risk.
    Type of Medium: Online Resource
    ISSN: 0891-9887 , 1552-5708
    URL: Article
    DOI: 10.1177/0891988713509138
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2094096-8
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  • 6
    Online Resource
    Online Resource
    Easier Grade Determination by Measurement in Wool Top
    SAGE Publications ; 1949
    In:  Textile Research Journal Vol. 19, No. 5 ( 1949-05), p. 278-282
    Details
    In: Textile Research Journal, SAGE Publications, Vol. 19, No. 5 ( 1949-05), p. 278-282
    Abstract: This paper is a discussion on the determination of the grade of wool top using sequential sampling, thereby minimizing the sample sizes. Industrial firms con ducting fineness testing and wool-grade variability determination will be interested in this presentation and approach, which is suggestive of considerable time-saving analysis.— Editor
    Type of Medium: Online Resource
    ISSN: 0040-5175 , 1746-7748
    URL: Article
    DOI: 10.1177/004051754901900505
    RVK:
    ZS 0001
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1949
    detail.hit.zdb_id: 2209596-2
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  • 7
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    Online Resource
    Diabetes and Cognitive Decline: Investigating the Potential Influence of Factors Related to Health Disparities
    SAGE Publications ; 2010
    In:  Journal of Aging and Health Vol. 22, No. 3 ( 2010-04), p. 292-306
    Details
    In: Journal of Aging and Health, SAGE Publications, Vol. 22, No. 3 ( 2010-04), p. 292-306
    Abstract: Objectives: The authors investigated whether factors related to health disparities—race, rural residence, education, perceived racial discrimination, vascular disease, and health care access and utilization—may moderate the association between diabetes and cognitive decline. Method: Participants were 624 community-dwelling older adults (49% African American and 49% rural) who completed in-home mini-mental state examination at baseline and 4-year follow-up. Results: Diabetes at baseline predicted four-year cognitive decline in regression models adjusted for a number of possible confounds. Only perceived discrimination and health utilization showed significant interaction effects with diabetes. Among African Americans who reported experiencing racial discrimination, there was a stronger relationship between diabetes and cognitive decline. Among participants who reported absence of visiting a physician within the past 6 months, the association between diabetes and cognitive decline was substantially larger. Discussion: Findings suggest that factors related to health disparities may influence cognitive outcomes among older adults with diabetes.
    Type of Medium: Online Resource
    ISSN: 0898-2643 , 1552-6887
    URL: Article
    DOI: 10.1177/0898264309357445
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2034469-7
    SSG: 5,2
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