Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries.

BACKGROUND: We investigated outcomes in patients with intracerebral haemorrhage (ICH) according to prior anticoagulation treatment with Vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) or no anticoagulation. METHODS: This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway (2013-2019). We included all consecutive patients with ICH from both registries. The main outcomes were favourable functional outcome (modified Rankin Scale 0-2) and mortality at 3 months. RESULTS: Among 11 349 patients with ICH (mean age 73.6 years; 47.6% women), 1491 (13.1%) were taking VKAs and 1205 (10.6%) DOACs (95.2% factor Xa inhibitors). The median percentage of patients on prior anticoagulation was 23.7 (IQR 22.6-25.1) with VKAs decreasing (from 18.3% to 7.6%) and DOACs increasing (from 3.0% to 18.0%) over time. Prior VKA therapy (n=209 (22.3%); adjusted ORs (aOR), 0.64; 95% CI, 0.49 to 0.84) and prior DOAC therapy (n=184 (25.7%); aOR, 0.64; 95% CI, 0.47 to 0.87) were independently associated with lower odds of favourable outcome compared with patients without anticoagulation (n=2037 (38.8%)). Prior VKA therapy (n=720 (49.4%); aOR, 1.71; 95% CI, 1.41 to 2.08) and prior DOAC therapy (n=460 (39.7%); aOR, 1.28; 95% CI, 1.02 to 1.60) were independently associated with higher odds of mortality compared with patients without anticoagulation (n=2512 (30.2%)). CONCLUSIONS: The spectrum of anticoagulation-associated ICH changed over time. Compared with patients without prior anticoagulation, prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3 months. Specific reversal agents unavailable during the study period might improve outcomes of DOAC-associated ICH in the future.

CADMUS: A Novel MRI-Based Classification of Spontaneous Intracerebral Hemorrhage Associated With Cerebral Small Vessel Disease

BACKGROUND AND OBJECTIVES: Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS: We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS: The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION: CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.

Relative power and interpersonal trust.

Because trust is essential in the development and maintenance of well-functioning relationships, scholars across numerous scientific disciplines have sought to determine what causes people to trust others. Power dynamics are known to predict trust, but research on the relationship between power and trust is inconclusive, with mixed results and without systematic consideration of how the relative power distribution within dyadic relationships may influence trust in those relationships. Building on interdependence theory, we propose that both individuals in an unequal-power dyad trust each other less than individuals in an equal-power dyad because unequal-power dyads heighten the perception of a conflict of interest. We demonstrate the effect of relative power on interpersonal trust across eight main studies and 16 supplemental studies (including 12 preregistered studies; total N = 10,531), and we test the mechanism with measurement-of-mediation and moderation-of-process approaches. We confirm that the effect of power on interpersonal trust occurs only with relative power (an interpersonal manifestation of power), not with felt power (an intrapersonal manifestation). Finally, we show that the effect of relative power on interpersonal trust via conflict of interest is attenuated in the presence of intergroup competition, a theoretically motivated moderator with practical implications. Overall, the present research clarifies the relationship between relative power and interpersonal trust, suggests that high- and low-power individuals may share similar psychological experiences within the context of unequal-power relationships, and highlights the importance of considering the context in which power dynamics occur. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry.

Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time. Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday-Friday 8:00-17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months. Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59-116) vs 95 (66-130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04-1.18]) and increased mortality (1.13 [95%CI: 1.01-1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased. Discussion and Conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.

Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE: Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce. METHODS: We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). RESULTS: We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031). CONCLUSIONS: Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.

Magnetic Resonance Imaging or Computed Tomography for Suspected Acute Stroke: Association of Admission Image Modality with Acute Recanalization Therapies, Workflow Metrics, and Outcomes.

OBJECTIVE: To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door-to-needle (DTN) time, door-to-puncture (DTP) time, and functional outcome between patients with admission magnetic resonance imaging (MRI) versus computed tomography (CT). METHODS: An observational cohort study of consecutive patients using a target trial design within the nationwide Swiss-Stroke-Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed-effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0-2) at 90 days. RESULTS: Of the 11,049 patients included (mean [SD] age, 71 [15] years; 4,811 [44%] women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median [interquartile range] 2 [0-6] vs 4 [1-11]), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73-0.96), but not with MT (aOR 1.11, 0.93-1.34); longer adjusted DTN (+22 min [13-30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30-1.81). INTERPRETATION: We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue-based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184-194.

Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation.

OBJECTIVE: The aim was to evaluate, in patients with atrial fibrillation (AF) and acute ischemic stroke, the association of prior anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) with stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes. METHODS: This was a cohort study of consecutive patients (2014-2019) on anticoagulation versus those without (controls) with regard to stroke severity, rates of IVT/mechanical thrombectomy, symptomatic intracranial hemorrhage (sICH), and favorable outcome (modified Rankin Scale score 0-2) at 3 months. RESULTS: Of 8,179 patients (mean [SD] age, 79.8 [9.6] years; 49% women), 1,486 (18%) were on VKA treatment, 1,634 (20%) on DOAC treatment at stroke onset, and 5,059 controls. Stroke severity was lower in patients on DOACs (median National Institutes of Health Stroke Scale 4, [interquartile range 2-11]) compared with VKA (6, [2-14]) and controls (7, [3-15], p < 0.001; quantile regression: ß -2.1, 95% confidence interval [CI] -2.6 to -1.7). The IVT rate in potentially eligible patients was significantly lower in patients on VKA (156 of 247 [63%]; adjusted odds ratio [aOR] 0.67; 95% CI 0.50-0.90) and particularly in patients on DOACs (69 of 464 [15%]; aOR 0.06; 95% CI 0.05-0.08) compared with controls (1,544 of 2,504 [74%]). sICH after IVT occurred in 3.6% (2.6-4.7%) of controls, 9 of 195 (4.6%; 1.9-9.2%; aOR 0.93; 95% CI 0.46-1.90) patients on VKA and 2 of 65 (3.1%; 0.4-10.8%, aOR 0.56; 95% CI 0.28-1.12) of those on DOACs. After adjustments for prognostic confounders, DOAC pretreatment was associated with a favorable 3-month outcome (aOR 1.24; 1.01-1.51). INTERPRETATION: Prior DOAC therapy in patients with AF was associated with decreased admission stroke severity at onset and a remarkably low rate of IVT. Overall, patients on DOAC might have better functional outcome at 3 months. Further research is needed to overcome potential restrictions for IVT in patients taking DOACs. ANN NEUROL 2021;89:42-53.

Getting back to the "new normal": Autonomy restoration during a global pandemic.

We investigate the psychological recovery process of full-time employees during the 2-week period at the onset of the Coronavirus pandemic (COVID-19). Past research suggests that recovery processes start after stressors abate and can take months or years to unfold. In contrast, we build on autonomy restoration theory to suggest that recovery of impaired autonomy starts immediately even as a stressor is ongoing. Using growth curve modeling, we examined the temporal trajectories of two manifestations of impaired autonomy-powerlessness and (lack of) authenticity-to test whether recovery began as the pandemic unfolded. We tested our predictions using a unique experience-sampling dataset collected over a 2-week period beginning on the Monday after COVID-19 was declared a "global pandemic" by the World Health Organization and a "national emergency" by the U.S. Government (March 16-27, 2020). Results suggest that autonomy restoration was activated even as the pandemic worsened. Employees reported decreasing powerlessness and increasing authenticity during this period, despite their subjective stress-levels not improving. Further, the trajectories of recovery for both powerlessness and authenticity were steeper for employees higher (vs. lower) in neuroticism, a personality characteristic central to stress reactions. Importantly, these patterns do not emerge in a second experience-sampling study collected prior to the COVID-19 crisis (September 9-20, 2019), highlighting how the pandemic initially threatened employee autonomy, but also how employees began to recover their sense of autonomy almost immediately. The present research provides novel insights into employee well-being during the COVID-19 pandemic and suggests that psychological recovery can begin during a stressful experience. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Power and negotiation: review of current evidence and future directions.

This review synthesizes the impact of power on individual and joint negotiation performance. Although power generally has positive effects on negotiators' individual performance (value claiming), recent work suggests that more power is not always beneficial. Taking a dyadic perspective, we also find mixed evidence for how power affects joint performance (value creation); some studies show that equal-power dyads create more value than unequal-power dyads, but others find the opposite. We identify the source of power, power distribution, and competitiveness as critical moderators of this relationship. Finally, we suggest that future research should move beyond studying alternatives in dyadic deal-making, identify strategies to overcome a lack of power,increase empirical realism, and take a more dynamic view of power in negotiations.

Imaginary alternatives: The effects of mental simulation on powerless negotiators.

This research demonstrates that people can act more powerfully without having power. Researchers and practitioners advise people to obtain alternatives in social exchange relationships to enhance their power. However, alternatives are not always readily available, often forcing people to interact without having much power. Building on research suggesting that subjective power and objective outcomes are disconnected and that mental simulation can improve aspirations, we show that the mental imagery of a strong alternative can provide some of the benefits that real alternatives provide. We tested this hypothesis in one context of social exchange-negotiations-and demonstrate that imagining strong alternatives (vs. not) causes powerless individuals to negotiate more ambitiously. Negotiators reached more profitable agreements when they had a stronger tendency to simulate alternatives (Study 1) or when they were instructed to simulate an alternative (Studies 3-6). Mediation analyses suggest that mental simulation enhanced performance because it boosted negotiators' aspirations and subsequent first offers (Studies 2-6), but only when the simulated alternative was attractive (Study 5). We used various negotiation contexts, which also allowed us to identify important boundary conditions of mental simulations in interdependent settings: mental simulation no longer helped when negotiators did not make the first offer, when their opponents simultaneously engaged in mental simulation (Study 6), and even backfired in settings where negotiators' positions were difficult to reconcile (Study 7). An internal meta-analysis of the file-drawer produces conservative effect size estimates and demonstrates the robustness of the effect. We contribute to social power, negotiations, and mental simulation research. (PsycINFO Database Record

Advice Giving: A Subtle Pathway to Power.

We propose that interpersonal behaviors can activate feelings of power, and we examine this idea in the context of advice giving. Specifically, we show (a) that advice giving is an interpersonal behavior that enhances individuals' sense of power and (b) that those who seek power are motivated to engage in advice giving. Four studies, including two experiments ( N = 290, N = 188), an organization-based field study ( N = 94), and a negotiation simulation ( N = 124), demonstrate that giving advice enhances the adviser's sense of power because it gives the adviser perceived influence over others' actions. Two of our studies further demonstrate that people with a high tendency to seek power are more likely to give advice than those with a low tendency. This research establishes advice giving as a subtle route to a sense of power, shows that the desire to feel powerful motivates advice giving, and highlights the dynamic interplay between power and advice.

The Too-Much-Precision Effect.

Past research has suggested a fundamental principle of price precision: The more precise an opening price, the more it anchors counteroffers. The present research challenges this principle by demonstrating a too-much-precision effect. Five experiments (involving 1,320 experts and amateurs in real-estate, jewelry, car, and human-resources negotiations) showed that increasing the precision of an opening offer had positive linear effects for amateurs but inverted-U-shaped effects for experts. Anchor precision backfired because experts saw too much precision as reflecting a lack of competence. This negative effect held unless first movers gave rationales that boosted experts' perception of their competence. Statistical mediation and experimental moderation established the critical role of competence attributions. This research disentangles competing theoretical accounts (attribution of competence vs. scale granularity) and qualifies two putative truisms: that anchors affect experts and amateurs equally, and that more precise prices are linearly more potent anchors. The results refine current theoretical understanding of anchoring and have significant implications for everyday life.

Data from a pre-publication independent replication initiative examining ten moral judgement effects.

We present the data from a crowdsourced project seeking to replicate findings in independent laboratories before (rather than after) they are published. In this Pre-Publication Independent Replication (PPIR) initiative, 25 research groups attempted to replicate 10 moral judgment effects from a single laboratory's research pipeline of unpublished findings. The 10 effects were investigated using online/lab surveys containing psychological manipulations (vignettes) followed by questionnaires. Results revealed a mix of reliable, unreliable, and culturally moderated findings. Unlike any previous replication project, this dataset includes the data from not only the replications but also from the original studies, creating a unique corpus that researchers can use to better understand reproducibility and irreproducibility in science.

Anchors weigh more than power: why absolute powerlessness liberates negotiators to achieve better outcomes.

The current research shows that having no power can be better than having a little power. Negotiators prefer having some power (weak negotiation alternatives) to having no power (no alternatives). We challenge this belief that having any alternative is beneficial by demonstrating that weak alternatives create low anchors that reduce the value of first offers. In contrast, having no alternatives is liberating because there is no anchor to weigh down first offers. In our experiments, negotiators with no alternatives felt less powerful but made higher first offers and secured superior outcomes compared with negotiators who had weak alternatives. We established the role of anchoring through mediation by first offers and through moderation by showing that weak alternatives no longer led to worse outcomes when negotiators focused on a countervailing anchor or when negotiators faced an opponent with a strong alternative. These results demonstrate that anchors can have larger effects than feelings of power. Absolute powerlessness can be psychologically liberating.

The too-much-talent effect: team interdependence determines when more talent is too much or not enough.

Five studies examined the relationship between talent and team performance. Two survey studies found that people believe there is a linear and nearly monotonic relationship between talent and performance: Participants expected that more talent improves performance and that this relationship never turns negative. However, building off research on status conflicts, we predicted that talent facilitates performance-but only up to a point, after which the benefits of more talent decrease and eventually become detrimental as intrateam coordination suffers. We also predicted that the level of task interdependence is a key determinant of when more talent is detrimental rather than beneficial. Three archival studies revealed that the too-much-talent effect emerged when team members were interdependent (football and basketball) but not independent (baseball). Our basketball analysis also established the mediating role of team coordination. When teams need to come together, more talent can tear them apart.

Model-based evaluation of reduction strategies for micropollutants from wastewater treatment plants in complex river networks.

A model based on graph theory was developed to efficiently evaluate the impact of the effluent from 742 wastewater treatment plants (WWTPs) on micropollutant loading throughout all river catchments in Switzerland. Model results agree well with measured loads for 12 compounds in river water samples, revealing mean predictive accuracy factors between 0.8 and 3.4. Subsequently, pollutant concentrations were predicted for river sections downstream from 543 WWTPs where hydrological information was available, and compared with recent recommendations for water quality criteria. At base flow conditions, carbamazepine concentrations (parent compound only) are ubiquitously below a water quality criterion of 0.5 microg L(-1). In contrast, the sum of diclofenac and its metabolites is expected to exceed the corresponding water quality criterion of 0.1 microg L(-1) in 224 river sections. If diclofenac cannot be eliminated atthe source, the model suggests a directed upgrade of 173 WWTPs to meet the condition that concentrations are never to exceed this water quality criterion.