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Why do so people often pursue social rank using coercive and potentially costly dominance-oriented strategies (grounded in fear and intimidation) rather than noncoercive prestige-oriented strategies (grounded in respect and admiration)? In 10 studies (N = 3,372, including a high-powered preregistered replication), we propose that people's beliefs about the nature of social hierarchies shape their preference for dominance strategies. Specifically, we find that zero-sum beliefs about social hierarchies -- beliefs that one person's rise in social rank inevitably comes at others' expense--drive the preference for dominance-oriented, but not prestige-oriented, approaches to status. The more participants viewed social hierarchies as zero-sum, the more they were willing to use dominance tactics and the more interested they were in reading books about how to use such tactics. Moreover, we find evidence that zerosum beliefs about social hierarchies causally increase the preference for dominance-oriented, but not prestige-oriented, strategies for gaining rank, and that both objective factors in the organizational environment and people's subjective interpretations of these environments can trigger this effect. We discuss implications for the intragroup and intergroup dynamics of attaining and retaining high social rank. [ABSTRACT FROM AUTHOR]

This investigation sought to expand the theoretical and practical knowledge of intervention approaches to reduce the risk of interethnic violence and extremism in fragile contexts by leveraging increases in cognitive complexity and resilience among at-risk young Bosniaks, Serbs, and Croats (n = 121, ages 16-33) in Bosnia and Herzegovina (BiH). Low cognitive complexity, characterized by categorical thinking that does not recognize the validity of other viewpoints, is an important psychological predictor of violence in intergroup conflicts (Suedfeld et al., Looking back, looking forward: Perspectives on terrorism and responses to it, strategic multi-layer assessment, 2013). In collaboration with the International Organization of Migration (IOM), local experts, and community members, a multiday course was developed, piloted, and tested in ten ethnically representative towns and villages across BiH which aimed to enhance participants' cognitive complexity on contested social issues. To do this, the intervention used structured group activities and facilitator-led reflections to develop meta-awareness of thoughts and feelings when engaging with group dynamics. Pre- and posttesting over ten courses showed that, as hypothesized, cognitive complexity increased significantly by the end of the course (Cohen's d = .78, 95% CI [.53, 1.02]). Resilience and cognitive perspective-taking scores also increased significantly. Without a control group, causal inferences should be made cautiously and in concert with additional evidence. Follow-up monitoring deployed by the funding organization suggested continued benefits at 6 and 12 months after the course. Implications for broader prevention efforts are discussed. [ABSTRACT FROM AUTHOR]

Frailty is a distinctive health state in which the ability of older people to cope with acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems. Although closely associated with age, multimorbidity, and disability, frailty is a discrete syndrome that is associated with poorer outcomes across a range of medical conditions. However, its role in cerebrovascular disease and stroke has received limited attention. The estimated rise in the prevalence of frailty associated with changing demographics over the coming decades makes it an important issue for stroke practitioners, cerebrovascular research, clinical service provision, and stroke survivors alike. This review will consider the concept and models of frailty, how frailty is common in cerebrovascular disease, the impact of frailty on stroke risk factors, acute treatments, and rehabilitation, and considerations for future applications in both cerebrovascular clinical and research settings. [ABSTRACT FROM AUTHOR]

Introduction Mechanical thrombectomy (MT) can improve outcomes following ischaemic stroke. Patient selection for MT is predominantly based on physiological and imaging parameters. We assessed whether people living with pre-stroke frailty had differing outcomes following MT. Methods We included consecutive patients undergoing MT at a UK comprehensive stroke centre. We calculated a cumulative deficits frailty index to identify pre-stroke frailty in those patients presenting directly to the centre. Frailty was defined as an index score ≥ 0.24. We assessed univariable and multivariable association between pre-stroke frailty and stroke outcomes. Our primary outcomes were modified Rankin Scale (mRS) and mortality at 90 days. Results Of 175 patients who underwent MT (2014–2018), we identified frailty in 49 (28%). Frail and non-frail patients had similar rates of thrombolysis administration, successful recanalization and onset to recanalization times. Those with pre-stroke frailty had higher 24 hour National Institutes of Health Stroke Scale (12(IQR: 8–17) versus 3(IQR: 2–13); P  = 0.001); were less likely to be independent (mRS 0–2: 18% versus 61%; P  < 0.001) and more likely to die (47% versus 14%; P  < 0.001) within 90 days. Adjusting for age, baseline NIHSS and thrombolysis, frailty remained a strong, independent predictor of poor clinical outcome at 90 days (Death OR: 3.12 (95% CI: 1.32–7.4); dependency OR: 3.04 (95%CI: 1.10–8.44). Age was no longer a predictor of outcome when adjusted for frailty. Conclusion Pre-stroke frailty is prevalent in real-world patients eligible for MT and is an important predictor of poor outcomes. Routine assessment of pre-stroke frailty could help decision-making around patient selection for MT. [ABSTRACT FROM AUTHOR]

Background: Mechanical thrombectomy has revolutionised the treatment of acute ischaemic stroke due to large vessel occlusion. It is well recognised that patients are more likely to benefit when reperfusion happens quickly, however, there is uncertainty as to how best to deliver this service. Objectives: To compare outcomes of patients in Northern -Ireland who underwent thrombectomy via direct admission to the single endovascular centre (mothership [MS]) with those transferred from primary stroke centres (drip-and-ship [DS]). Methods: Analysis was conducted on the records of all patients who underwent thrombectomy from January 2014 to December 2017 inclusive. The primary outcome measure was 3 months functional independence (modified Rankin Score [mRS] 0–2). Secondary outcome measures were full recovery (mRS 0) at 3 months, symptomatic intracranial haemorrhage (sICH) rates and mortality rates. Results: Two hundred fourteen patients underwent thrombectomy (MS 124, DS 90). Patients in the MS group were older (median 73 vs. 70 years, p = 0.026), but there was no significant difference in baseline National Institutes of Health Stroke Scale (median 15 MS vs. 16.5 DS, p = 0.162) or thrombolysis rates (41.9% MS vs. 54.4% DS, p = 0.070) between the groups. Time from stroke onset to arrival at thrombectomy centre was shorter in the MS group (median 71 vs. 218 min, p < 0.001) but door to groin puncture time was shorter in the DS group (median 30 vs. 60 min, p < 0.001). There was no significant difference in 3 months functional independence (51.6% MS vs. 62.2% DS, p = 0.123), or in the secondary outcome measures of full recovery (21.8% MS vs. 12.2% DS, p = 0.071), sICH (MS 0.8%, DS 4.4%, p = 0.082) and mortality (MS 24.2%, DS 20.0%, p = 0.468). Conclusions: Our analysis showed similar outcomes after thrombectomy in the MS and DS groups. For patients potentially eligible for thrombectomy, rapid access to the endovascular centre is essential to optimise both the number of patients treated and the outcomes achieved. [ABSTRACT FROM AUTHOR]

Background: Lay involvement in implementation of research evidence into practice may include using research findings to guide individual care, as well as involvement in research processes and policy development. Little is known about the conditions required for such involvement. Aim: To assess stroke survivors’ research awareness, use of research evidence in their own care and readiness to be involved in research processes. Methods: Cross sectional survey of stroke survivors participating in population‐based stroke registers in six European centres. Results: The response rate was 74% (481/647). Reasons for participation in register research included responding to clinician request (56%) and to ‘give something back’ (19%); however, 20% were unaware that they were participating in a stroke register. Research awareness was generally low: 57% did not know the purpose of the register they had been recruited to; 73% reported not having received results from the register they took part in; 60% did not know about any research on stroke care. Few participants (7.6%) used research evidence during their consultations with a doctor. The 34% of participants who were interested in being involved in research were younger, more highly educated and already research aware. Conclusions: Across Europe, stroke survivors already participating in research appear ill informed about stroke research. Researchers, healthcare professionals and patient associations need to improve how research results are communicated to patient populations and research participants, and to raise awareness of the relationship between research evidence and increased quality of care. [ABSTRACT FROM AUTHOR]