Automated Assessment of the DWI-FLAIR Mismatch in Patients with Acute Ischemic Stroke: Added Value to Routine Clinical Practice.

BACKGROUND AND PURPOSE: The DWI-FLAIR mismatch is used to determine thrombolytic eligibility in patients with acute ischemic stroke when the time since stroke onset is unknown. Commercial software packages have been developed for automated DWI-FLAIR classification. We aimed to use e-Stroke software for automated classification of the DWI-FLAIR mismatch in a cohort of patients with acute ischemic stroke and in a comparative analysis with 2 expert neuroradiologists. MATERIALS AND METHODS: In this retrospective study, patients with acute ischemic stroke who had MR imaging and known time since stroke onset were included. The DWI-FLAIR mismatch was evaluated by 2 neuroradiologists blinded to the time since stroke onset and automatically by the e-Stroke software. After 4 weeks, the neuroradiologists re-evaluated the MR images, this time equipped with automated predicted e-Stroke results as a computer-assisted tool. Diagnostic performances of e-Stroke software and the neuroradiologists were evaluated for prediction of DWI-FLAIR mismatch status. RESULTS: A total of 157 patients met the inclusion criteria. A total of 82 patients (52%) had a time since stroke onset of ≤4.5 hours. By means of consensus reads, 81 patients (51.5%) had a DWI-FLAIR mismatch. The diagnostic accuracy (area under the curve/sensitivity/specificity) of e-Stroke software for the determination of the DWI-FLAIR mismatch was 0.72/90.0/53.9. The diagnostic accuracy (area under the curve/sensitivity/specificity) for neuroradiologists 1 and 2 was 0.76/69.1/84.2 and 0.82/91.4/73.7, respectively; both significantly (P < .05) improved to 0.83/79.0/86.8 and 0.89/92.6/85.5, respectively, following the use of e-Stroke predictions as a computer-assisted tool. The interrater agreement (κ) for determination of DWI-FLAIR status was improved from 0.49 to 0.57 following the use of the computer-assisted tool. CONCLUSIONS: This automated quantitative approach for DWI-FLAIR mismatch provides results comparable with those of human experts and can improve the diagnostic accuracies of expert neuroradiologists in the determination of DWI-FLAIR status.

Breastfeeding and cognitive development of children: assessment at one year of age.

Breastfeeding is the fundamental component of child survival strategy. It significantly influences neurological development of children. The study was conducted to assess whether exclusive and prolonged breastfeeding improves children's cognitive development, including low birth weight (LBW) babies, in a developing country setting like Bangladesh. This observational study was done on a cohort of newborn infants who were discharged from the special care baby unit of Dhaka Shishu Hospital during January 2006 to December 2008 with proper counseling about exclusive and prolonged breastfeeding. Their neuro-developmental follow-up was started at 4 weeks postnatal age and continued at 3-monthly intervals up to 1 year of age. At each visit, cognitive development was assessed using the Bayley Scales of Infant Development (BSID II). Cognitive development was compared between the babies of exclusive vs. non exclusive breastfeeding, normal weight vs. low birth weight and male vs. female babies. A total of 105 cases were successfully followed-up during this period. Out of these 47(44.8%) babies were exclusively breastfed up to 6 month of age and 58(55.2%) were in nonexclusive group. Overall Psychomotor Development Index (PDI) was slightly more (108.40 ± 23.06 vs. 103.23 ± 19.87) in the exclusive breast fed babies in comparison to nonexclusive breast fed babies, but was significantly more in babies having birth weight >2.5 kg in comparison to those having birth weight of <2.5 kg. Other parameters of cognitive development were more or less same in both normal and LBW groups. Mental and motor development was same in both boys and girls. In behavior ratings, cooperation was significantly high (5.89 ± 2.54 vs. 4.71 ± 3.13, p=0.05) and vocalization (5.89 ± 1.07 vs. 4.58 ± 1.16) was also high, though not significant, in girls than boys.

The elusive agenda: mainstreaming women in development.

PIP: The first part of this essay on mainstreaming women in development outlines the hard-won achievements of the women's movement in the past 20 years and acknowledges that the movement has failed to gain its fundamental objectives of transforming social and gender relations and creating a just and equal world. Considering the central question of why progress has been so elusive for women, the essay notes that the agenda the movement articulated challenged male power and privilege and called for investment in women that would require reallocation of existing resources or finding additional sources of revenue. Because women are differentiated by class, race, and nation, it is difficult to shape women into a powerful political constituency. Thus, the women's movement should adopt an agenda-setting approach and take a consistent stand on a core agenda. The next part of the essay describes some of the changes that a shift from an integrationist to an agenda-setting approach will entail and notes that this approach will require: 1) women to play a proactive leadership role and to clearly articulate a core agenda, 2) the strategic positioning of gender concerns in a period of change, 3) strengthening women's groups and networks, 4) using a new communication strategy to expand support, 5) developing context-specific concepts and analytical tools, and 6) building institutional capacities of aid recipients. The final section of essay notes that agenda-setting will raise awareness of the need to promote the equitable sharing of responsibilities in institutions such as families, communities, national governments, and global institutions.^ieng

The International Women's Year Conference and Tribune.

PIP: Two accounts of the proceedings of the International Women's Year (IWY) Conference and the Tribune held in Mexico City in June and July of 1975 are provided by two delegates to the Conference from the Society for International Development. The first delegate provides a set of impressionistic observations of the conference proceedings and makes the following points: 1) The IWY conference has made it respectable and legitimate to speak of women's concerns in major public forums; 2) Conference deliberations became politicized, reflecting differences among the various governments represented by the women delegates; 3) A flood of amendments failed to prevent the enactment of a Plan of Action containing various objectives for advancing the causes of women. The second delegate's account also notes the politicization of the conference, describing the major political controversy as being over the developing countries' insistence that women's problems were intractable until the old economic order was overthrown. In contrast, the developed countries emphasized sexism and a focus upon order. Equality of sexes was another area of disagreement between developed and developing countries. The latter argued for complementarity of sexual roles while the former argued for sexual equality. In conlusion, it was felt that the IWY Conference's value was primarily symbolic.^ieng