WorldWideScience

Sample records for stroke fast-tracks return

  1. PUC fast track nips returns

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    In the first of what it says will be annual cost-of-capital proceedings to set returns on equity and rates of return on rate base for electric utilities, the California Public Utilities Commission (PUC) lowered from 1989 levels the 1990 returns on common equity (ROE) and rates of return (ROR) for the state's four major investor-owned electric utilities. Under this fast-track procedure, by May 8 of every year, utilities will have to file an application for rate adjustments that reflect their projected costs of capital for the following year

  2. Fast track-hoftealloplastik

    DEFF Research Database (Denmark)

    Hansen, Torben Bæk; Gromov, Kirill; Kristensen, Billy B

    2017-01-01

    Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased...... morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden....

  3. Fast-track surgery in India.

    Science.gov (United States)

    Nanavati, Aditya J; Nagral, Sanjay; Prabhakar, Subramaniam

    2014-01-01

    Fast-track surgery or 'enhanced recovery after surgery' or 'multimodal rehabilitation after surgery' is a form of protocol-based perioperative care programme. It is an amalgamation of evidence-based practices that have been proven to improve patient outcome independently and exert a synergistic effect when applied together. The philosophy is to treat the patient's pathology with minimal disturbance to the physiology. Several surgical subspecialties have now adopted such protocols with good results. The role of fast-track surgery in colorectal procedures has been well demonstrated. Its application to other major abdominal surgical procedures is not as well defined but there are encouraging results in the few studies conducted. There has been resistance to several aspects of this programme among gastrointestinal and general surgeons. There is little data from India in the available literature on the application of fast-tracking in gastrointestinal surgery. In a country such as India the existing healthcare structure stands to gain the most by widespread adoption of fast-track methods. Early discharge, early ambulation, earlier return to work and increased hospital efficiency are some of the benefits. The cost gains derived from this programme stand to benefit the patient, doctor and government as well. The practice and implementation of fast-track surgery involves a multidisciplinary team approach. It requires policy formation at an institutional level and interdepartmental coordination. More research is required in areas like implementation of such protocols across India to derive the maximum benefit from them. Copyright 2014, NMJI.

  4. Standardising fast-track surgical nursing care in Denmark

    DEFF Research Database (Denmark)

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik

    2014-01-01

    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN...

  5. Physical activity and return to work after fast-track total hip replacement with or without supervised rehabilitation. Results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Søballe, Kjeld

    Background Total hip replacement (THR) results in pain reduction and functional improvements. However, it is suggested that these improvements are not followed by increases in physical activity level and return to usual activities postoperatively. Furthermore, it is unknown whether supervised...

  6. Physical activity and return to work after fast-track total hip replacement with or without supervised rehabilitation. Results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Søballe, Kjeld

    rehabilitation affects the activity level as well as return to work after THR. Purpose/Aim of Study To investigate whether supervised progressive resistance training during the first 10 weeks after THR affects the change in physical activity level from baseline to 6 months after THR and the timing of return...... activity was measured in metabolic equivalents (MET) by Physical Activity Scale (PAS) and days until return to work for the working population. Findings / Results Follow up was completed by 62 patients (85%). Changes in PAS scores from baseline to 6 months follow up were, mean [95% CI]: IG: 6.32 [3...... their self-reported physical activity level more than patients performing home-based exercise only, during 6 months after THR however, the difference was eliminated at 1 year follow up. No significant difference was found concerning return to work....

  7. Fast-tracked Rehabilitation and Return to Sport of an Elite Rugby Player with a Complicated Posterolateral Corner Injury and Associated Peroneal Paralysis

    NARCIS (Netherlands)

    Paget, L. D. A.; Kuijer, P. P. F. M.; Maas, M.; Kerkhoffs, G. M. M. J.

    2017-01-01

    Acute posterolateral corner injuries of the knee with associated hamstring avulsions and peroneal paralysis are rare in rugby. Regain of motor function following a complete paralysis is documented to be 38%. To our knowledge, only one case describes return to preinjury level of competitive sport

  8. Fast-Track Teacher Recruitment.

    Science.gov (United States)

    Grant, Franklin Dean

    2001-01-01

    Schools need a Renaissance human-resources director to implement strategic staffing and fast-track teacher-recruitment plans. The HR director must attend to customer satisfaction, candidate supply, web-based recruitment possibilities, stabilization of newly hired staff, retention of veteran staff, utilization of retired employees, and latest…

  9. Percentage of Fast-Track Receipts

    Data.gov (United States)

    Social Security Administration — The dataset provides the percentage of fast-track receipts by state during the reporting fiscal year. Fast-tracked cases consist of those cases identified as Quick...

  10. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  11. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...

  12. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...

  13. Important factors influencing the return to work after stroke.

    Science.gov (United States)

    Wang, Ying-Chih; Kapellusch, Jay; Garg, Arun

    2014-01-01

    As the field of rehabilitation shifts its focus towards improving functional capacity instead of managing disability, return to work (RTW) and return to the community emerge as key goals in a person's recovery from major disabling illness such as stroke. To compile important factors believed to influence RTW after a stroke. Based on a comprehensive literature review, we clustered similar factors and organized these factors based on the International Classification of Function, Disability and Health (ICF) framework: body functions or structure, activity participation, environmental factors and personal and psychosocial factors. Overall, stroke severity, as assessed by the degree of residual disability such as weakness, neurological deficit or impairments (speech, cognition, apraxia, agnosia), has been shown to be the most consistent negative predictor of RTW. Many factors such as the number of working years remaining until retirement, depression, medical history, and occupation need to be taken into consideration for stroke survivors, as they can influence RTW decision making. Stroke survivors who are flexible and realistic in their vocational goal and emotionally accept their disability appear more likely to return to work. There are many barriers to employment for stroke survivors ranging from physical and cognitive impairments to psychosocial and environmental factors.

  14. Factors affecting return to driving post-stroke.

    LENUS (Irish Health Repository)

    Tan, K M

    2012-02-01

    BACKGROUND: Stroke can affect a person\\'s ability to drive, an important means of transportation in the developed world. AIMS: To determine percentage of patients and factors associated with return to driving post-stroke in a service with emphasis on driver assessment. METHODS: Retrospective study of patients discharged from the Stroke Service of our 470-bed teaching hospital from 1998 to 2002. RESULTS: Of 72 drivers pre-stroke, 54% recalled a driving assessment and 68% returned to driving. Younger patients (58.6 +\\/- 12.0 vs. 66.5 +\\/- 10.5, p = 0.008) with lower Modified Rankin Score (median 1 vs. 2, p = 0.0001) and normal cognition (55 vs. 43%, p = 0.45) were more likely to resume driving. More patients who were assessed returned to driving than those who were not (74 vs. 61%, p = 0.31). CONCLUSIONS: A relatively high level of return to driving can be achieved post-stroke with a pro-active approach to driver assessment and rehabilitation. A structured assessment and referral programme should be offered where appropriate.

  15. Enterprise size and return to work after stroke.

    Science.gov (United States)

    Hannerz, Harald; Ferm, Linnea; Poulsen, Otto M; Pedersen, Betina Holbæk; Andersen, Lars L

    2012-12-01

    It has been hypothesised that return to work rates among sick-listed workers increases with enterprise size. The aim of the present study was to estimate the effect of enterprise size on the odds of returning to work among previously employed stroke patients in Denmark, 2000-2006. We used a prospective design with a 2 year follow-up period. The study population consisted of 13,178 stroke patients divided into four enterprise sizes categories, according to the place of their employment prior to the stroke: micro (1-9 employees), small (10-49 employees), medium (50-249 employees) and large (>250 employees). The analysis was based on nationwide data on enterprise size from Statistics Denmark merged with data from the Danish occupational hospitalisation register. We found a statistically significant association (p = 0.034); each increase in enterprise size category was followed by an increase in the estimated odds of returning to work. The chances of returning to work after stroke increases as the size of enterprise increases. Preventive efforts and research aimed at finding ways of mitigating the effect are warranted.

  16. Estimation of Lightning Return Stroke Speed Using Elve Observations

    Science.gov (United States)

    Blaes, P.; Marshall, R. A.; Inan, U.

    2014-12-01

    Elves are optical emissions in the D-region ionosphere that are a result of collisional heating from the intense lightning electromagnetic pulse (EMP). The shape of elves is determined by the EMP radiation pattern at D-region altitudes, which is in turn controlled by the geometry and current propagation properties of the return stroke channel. In particular, numerical simulation of the EMP-ionosphere interaction shows a strong relationship between the elve "hole" radius and the current return stroke speed. During the summer of 2013, hundreds of elves were observed from Langmuir Laboratory, in New Mexico, with the PIPER high-speed photometer. Of these, 55 had an appropriate viewing geometry in which the elve hole is observable and is not corrupted by cloud flashes or sprites. An "emission profile", characterizing the elve emissions versus radius and time, is fit to each of these events using a constrained least squares reconstruction, allowing easy extraction of the elve hole radius. Using these measured radii in conjunction with the numerical EMP model, we perform Bayesian inference to estimate the distribution of return stroke speeds. The MTLL engineering model is assumed for the current propagation with reasonable priors for the parameters. The results show a maximum a posteriori probability return stroke speed estimate of 0.64c for elve producing lightning.

  17. Survey of survivors' perspective on return to work after stroke.

    Science.gov (United States)

    Hartke, Robert J; Trierweiler, Robert

    2015-10-01

    To describe the development and results of a detailed survey on return to work (RTW) after stroke completed by survivors at various stages of recovery. This study used a multi-method qualitative and quantitative research strategy to design and implement a 39-item survey for stroke survivors. Individual interviews, focus groups, and working committees were used to conceptualize the issues and translate them into a survey format. Surveys were distributed in regular and electronic mail. Groups of rehabilitation professionals, employers, and stroke survivors were assembled to review findings and obtain feedback to aide in interpretation. Overall 715 surveys were completed. The respondents were on average 54 years of age, mostly white, well-educated, urban dwelling, and in skilled occupations. Results are described in seven areas: financial, stroke impairments, organizational, work and psychological issues, interpersonal support, and therapy. Several salient findings are described including the role of fatigue, under utilization of vocational rehabilitation (VR) services, and motivational factors related to finances, self-esteem, work, and workplace relationships. Although earning an income is a strong motivation to RTW, salary decreases in importance when compared with other psychological benefits. Fatigue was rated as the second highest impairment barrier to RTW and persisted as a relevant impediment over time. Attitudes of co-workers and flexibility in work schedule were viewed as most helpful to the RTW process, whereas work stress was viewed as the greatest impediment to return. Only 24% of the sample received VR counseling with more respondents receiving counseling if they returned 6 months or longer after their stroke. Other trends and clinical and research implications are discussed.

  18. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study.

    Science.gov (United States)

    Wichmann, Matthias W; Eben, Ricarda; Angele, Martin K; Brandenburg, Franzis; Goetz, Alwin E; Jauch, Karl-Walter

    2007-07-01

    Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery. Forty patients underwent either conventional or fast-track rehabilitation after colorectal surgery. In addition to clinical parameters (return of gastrointestinal function, food intake, pain score, complication rates and postoperative length of stay), we determined parameters of perioperative immunity by flow cytometry (lymphocyte subgroups) and enzyme-linked immunosorbent assay (interleukin-6). Our findings indicate a better-preserved cell-mediated immune function (T cells, T-helper cells, natural killer cells) after fast-track rehabilitation, whereas the pro-inflammatory response (C-reactive protein, interleukin-6) was unchanged in both study groups. Furthermore, we detected a significantly faster return of gastrointestinal function (first bowel movement P<0.001, food intake P<0.05), significantly reduced pain scores in the postoperative course (P < 0.05) and a significantly shorter length of postoperative stay (P<0.001) in patients undergoing fast-track rehabilitation. Fast-track rehabilitation after colorectal surgery results in better-preserved cell-mediated immunity when compared with conventional postoperative care. Furthermore, patients undergoing fast-track rehabilitation suffer from less pain and have a faster return of gastrointestinal function in the postoperative course. In addition, postoperative length of hospital stay was significantly shorter in fast-track patients.

  20. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors

    NARCIS (Netherlands)

    van der Kemp, Jet; Kruithof, Willeke J.; Nijboer, Tanja C. W.; van Bennekom, Coen A. M.; van Heugten, Caroline; Visser-Meily, Johanna M. A.

    2017-01-01

    A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht

  1. Anesthetic and adjunctive drugs for fast-track surgery.

    Science.gov (United States)

    Baldini, G; Carli, F

    2009-08-01

    With the changes in health care dictated by economic pressure, there has been a realization that hospital stay could be shortened without compromising quality of care. Advances in surgical technology and anesthetic drugs have made an impact in the way perioperative care is delivered with some emphasis on multidisciplinary approach. From the expansion of ambulatory care, lessons were learnt how to apply same concepts to major surgery with the understanding that interventions to attenuate the surgical stress would facilitate the return to "baseline". Beside minimal invasive approach to surgery, anesthesia interventions are arranged with the intent to decrease the negative effects of surgical stress and pain, to minimize the side effects of drugs and at the same time to facilitate the recuperation which follows after surgery. Fast-track or accelerated care encompasses many aspects of anesthesia care, not only preoperative preparation and prehabilitation, but intraoperative attenuation of surgical stress and postoperative rehabilitation. The anesthesiologist is part of this team with the specific mission to use medications and techniques which have the least side effects on organ functions, provide analgesia which in turn facilitates the intake of food and mobilization out of bed. This chapter has been conceived with the intention to direct the clinician towards procedure-specific protocols where the choice of medications and techniques is based on published evidence. The success of implementing fast-track depends more on dynamic harmony amongst the various participants (surgeons, anesthesiologists, nurses, nutrtionists, physiotherapists) than on reaching an optimum level of excellence at each separate organization level.

  2. Delirium in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Kurbegovic, Sorel; Andersen, Jens; Krenk, Lene

    2015-01-01

    BACKGROUND: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously...... demonstrated to enhance recovery and reduce morbidity. METHODS: Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. RESULTS: Total median length of hospital stay...

  3. Effect of an Emergency Department Fast Track on Press-Ganey Patient Satisfaction Scores

    Directory of Open Access Journals (Sweden)

    Hwang, Calvin E.

    2014-12-01

    Full Text Available Introduction: Mandated patient surveys have become an integral part of Medicare remuneration, putting hundreds of millions of dollars in funding at risk. The Centers for Medicare & Medicaid Services (CMS recently announced a patient experience survey for the emergency department (ED. Development of an ED Fast Track, where lower acuity patients are rapidly seen, has been shown to improve many of the metrics that CMS examines. This is the first study examining if ED Fast Track implementation affects Press-Ganey scores of patient satisfaction. Methods: We analyzed returned Press-Ganey questionnaires from all ESI 4 and 5 patients seen 11AM - 11PM, August-December 2011 (pre-fast track, and during the identical hours of fast track, August-December 2012. Raw ordinal scores were converted to continuous scores for paired student t-test analysis. We calculated an odds ratio with 100% satisfaction considered a positive response. Results: An academic ED with 52,000 annual visits had 140 pre-fast track and 85 fast track respondents. Implementation of a fast track significantly increased patient satisfaction with the following: wait times (68% satisfaction to 88%, OR 4.13, 95% CI [2.32-7.33], doctor courtesy (90% to 95%, OR 1.97, 95% CI [1.04-3.73], nurse courtesy (87% to 95%, OR 2.75, 95% CI [1.46-5.15], pain control (79% to 87%, OR 2.13, 95% CI [1.16-3.92], likelihood to recommend (81% to 90%, OR 2.62, 95% CI [1.42-4.83], staff caring (82% to 91%, OR 2.82, 95% CI [1.54-5.19], and staying informed about delays (66% to 83%, OR 3.00, 95% CI [1.65-5.44]. Conclusion: Implementation of an ED Fast Track more than doubled the odds of significant improvements in Press-Ganey patient satisfaction metrics and may play an important role in improving ED performance on CMS benchmarks. [West J Emerg Med. 2015;16(1:34–38.

  4. Fast-track knee arthroplasty – status and future challenges

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Thienpont, Emmanuel

    2013-01-01

    Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee a...

  5. Feasibility of fast-track elements in pediatric surgery.

    Science.gov (United States)

    Reismann, M; Arar, M; Hofmann, A; Schukfeh, N; Ure, B

    2012-02-01

    We recently showed that fast-track pathways could be applied to only one third of patients undergoing routine pediatric surgery. The aim of this study was to investigate various fast-track elements in various procedure types irrespective of the applicability of a whole fast-track pathway. Patients undergoing routine surgical procedures from April 2009 to April 2010 were included in the study. 11 groups of procedures were differentiated and quality criteria were established for 8 fast-track elements: analgesia, postoperative nutrition, postoperative mobilization, applicability of minimally invasive surgery when appropriate, hospital stay, postoperative symptoms, complications, and parental evaluation. A fast-track element was considered as successfully applied if used in at least 75% of patients. The hospital stay was compared with data from the German reimbursement system (G-DRG). A total of 203 patients were included. Optimal analgesia was achieved in all procedure types except in oncologic surgery (58%) and ureteral reimplantation (71%). Significant nausea and vomiting occurred only after Kasai operation and "other laparoscopic procedures". Early nutrition was achieved in all procedures except after fundoplication (67%) and Kasai operation (62%). Early postoperative mobilization was not successful after hypospadias repair (40%) and ureteral reimplantation (43%). Minimally invasive techniques could not be applied in 48% of thoracic procedures and in 58% of oncological patients. There were no fast-track associated complications. In 4 of 11 procedure types, the mean hospital stay was significantly reduced compared to G-DRG data. There were 4 readmissions (2%). 2 weeks after discharge 94% of interviewed parents evaluated fast-track treatment as excellent. Fast-track elements in pediatric surgery increase patient comfort, reduce hospital stay, and achieve a high patient satisfaction. We wish to emphasize the benefits of using fast-track elements irrespective of

  6. Cognitive dysfunction after fast-track hip and knee replacement

    DEFF Research Database (Denmark)

    Krenk, Lene; Kehlet, Henrik; Bæk Hansen, Torben

    2014-01-01

    , and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia......, early mobilization, and short length of stay (LOS ≤3 days) and discharged to home. METHODS: In a prospective multicenter study, we included 225 patients aged ≥60 years undergoing well-defined fast-track total hip or total knee replacement. Patients had neuropsychological testing preoperatively and 1...... this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). CONCLUSIONS: The incidence of POCD early after total hip and knee replacement seems to be lower after a fast-track approach than rates previously reported...

  7. Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

    DEFF Research Database (Denmark)

    Burgdorf, Stefan K; Rosenberg, Jacob

    2012-01-01

    a stoma (10 versus 10 days, ns), with no changes in the perioperative care regimens. Furthermore there were significant lower blood loss (50 versus 200 mL, P ... in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we aimed to reduce hospitalisation without increasing cost in nursing staff per hospital bed. Length of stay......Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks...

  8. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene

    2013-01-01

    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... to provide immediate advice and support. CONCLUSION: The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS...

  9. Delirium after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, L S; Hansen, T B

    2012-01-01

    BACKGROUND: /st>Postoperative delirium (PD) is a serious complication after major surgery in elderly patients. PD is well defined and characterized by reduced attention and disorientation. Multimodal optimization of perioperative care (the fast-track methodology) enhances recovery, and reduces...

  10. Waiting time at a fast-track diagnostic clinic

    NARCIS (Netherlands)

    Basta, Y. L.; Tytgat, K. M. A. J.; Klinkenbijl, J. H. G.; Fockens, P.; Smets, E. M. A.

    2016-01-01

    Purpose - Guidelines stating maximum waiting times fail to take cancer patients' expectations into account. Therefore, the purpose of this paper is to assess patients' expectations and experiences with their waiting time at a fast-track clinic. Design/methodology/approach - Patients were selected

  11. Fast Tracking East African Political Federation: The Role and ...

    African Journals Online (AJOL)

    The revival of the East African community (EAC) in 1999 ushered in new hope for the transformation of the region by a functioning entity with powers to allocate the resources necessary for development. However, the fast tracking East African political federation has failed to provide a clear link between itself – as a statutory

  12. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill

    2015-01-01

    BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which ma...

  13. A blueprint for multidisciplinary fast track gastrointestinal oncology care

    NARCIS (Netherlands)

    Basta, Y.L.

    2017-01-01

    In this thesis, we have evaluated the implementation of two key concepts of the Gastro Intestinal oncology Center Amsterdam (GIOCA): multidisciplinary teams (MDT) and the fast delivery of care in fast track clinics (FTC). The first part of this thesis investigates the value of multidisciplinary

  14. Patient-reported outcome after fast-track knee arthroplasty

    DEFF Research Database (Denmark)

    Larsen, Kristian; Hansen, Torben B; Søballe, Kjeld

    2012-01-01

    wanted to describe the association between physical function, health-related quality-of-life (HRQOL) and patient satisfaction. METHODS: The study consisted of 211 consecutive fast-track patients of which none received additional rehabilitation beyond an instructional exercise plan at discharge, which...

  15. Fast Track: Elementary School. What Works Clearinghouse Intervention Report

    Science.gov (United States)

    What Works Clearinghouse, 2014

    2014-01-01

    "Fast Track" is a comprehensive intervention designed to reduce conduct problems and promote academic, behavioral, and social improvement. The program's components include the "Promoting Alternative THinking Strategies" curriculum, parent groups, parent-child sharing time, child social skills training, home visiting, child…

  16. Return to Work after a Stroke in Working Age Persons; A Six-Year Follow Up.

    Directory of Open Access Journals (Sweden)

    Emma Westerlind

    Full Text Available Stroke is one of the most common and resource intensive diseases for society. Stroke in the working age population is increasing in different parts of the world. An incomplete return to work (RTW after sick leave post stroke entails negative consequences for the affected person and an economical burden for society. The aim of this study was to explore the RTW rate and factors associated with RTW in a six-year follow up post stroke.Data from 174 persons 63 years or younger, with first ever stroke in 2009-2010 in Gothenburg were analyzed. Baseline characteristics were collected through medical records and the Swedish Health Insurance Office provided information on sick leave up to 6 years post stroke. Time-to-event was presented and cox regression as well as logistic regression were used to analyze risk factors for no-RTW.The RTW rate was 74.7%, at the end of follow up. Participants continued to RTW until just over 3 years post stroke. Dependency at discharge (in the modified Rankin Scale and sick leave prior to the stroke were significant risk factors for no-RTW after 1 year with odds ratio 4.595 and 3.585, respectively. The same factors were significant in time-to-event within six years post stroke with hazard ratio 2.651 and 1.929, respectively.RTW after a stroke is incomplete, however RTW is possible over a longer period of time than previously thought. More severe disability at discharge from hospital and sick leave prior to the stroke were shown to be risk factors for no-RTW. This knowledge can contribute to more individualized vocational rehabilitation.

  17. Time trend analysis of return to work after stroke in Denmark 1996-2006

    DEFF Research Database (Denmark)

    Hannerz, Harald; Mortensen, Ole S; Poulsen, Otto M

    2012-01-01

    In the period 1997-2005, the Danish government initiated a series of legislative changes aimed at facilitating RTW (return to work) in the Danish population. In the present study, we investigated the odds of being gainfully occupied ca. two years after stroke as a function of onset calendar year...

  18. Approximate expressions for lightning electromagnetic fields at near and far ranges: Influence of return-stroke speed

    Science.gov (United States)

    Chen, Yazhou; Wang, Xiaojia; Rakov, Vladimir A.

    2015-04-01

    The waveforms of lightning return-stroke electromagnetic fields on ground are studied using the transmission line model. Approximate expressions to calculate lightning electromagnetic fields at near and far ranges are presented. It is found that the waveforms of lightning electric and magnetic fields in the time domain at both near and far ranges can be expressed approximately as the channel-base current waveform multiplied by a factor which is a function of the return-stroke speed v and the horizontal distance r between the return-stroke channel and the observation point on ground. The ranges at which the approximate expressions are valid are determined. The ranges of validity increase with increasing the return-stroke speed, and the near and far field approximate expressions converge to the exact formula as the return-stroke speed approaches the speed of light.

  19. Electric and Magnetic Fields from Lightning Return Strokes Measured in Prague

    Science.gov (United States)

    Kolmasova, I.; Santolik, O.; Chum, J.; Uhlir, L.; Hruska, F.; Base, J.; Novak, P.; Rauch, J.

    2011-12-01

    Using the electric dipole or the magnetic loop antenna we measure broadband magnetic field derivative and electric field waveforms from the lightning return strokes in the frequency range 5 kHz-37 MHz. We analyze the data collected during the ground-based observational campaign in summer 2011 in Prague, Czech Republic. The recorded data originated from thunderstorms that occurred in the vicinity of the measuring site. We used the ground based version of the high frequency analyzer IME-HF, which is currently developed for the TARANIS (Tool for the Analysis of Radiation from lightNIng and Sprites) spacecraft mission. Selected interesting parts of the waveforms are sampled at 80 MHz and recorded. The data acquisition system of the analyzer is triggered from intense signals in the twelve frequency bands. The analyzer also uses a circular buffer memory to record the 80-MHz waveforms both before and after the trigger time. The triggering algorithm is very flexible with many adjustable parameters. The threshold for triggering is calculated as a sum of weighted differences between the maximum and average root-mean-square values in twelve band-pass filters. The results show that there are large variations in the shapes of radiated field by return strokes of lightning flashes which depend on different positions and types of the strokes. We noted the HF noise at ~ 20 MHz in the dB/dt records after the main peak of the first return stroke, which is probably related to the presence of branches and the currents flowing in them. The spectra of dB/dt and E waveforms are different for the first and subsequent return strokes. We have found more than 30 records with the Regular Pulses Bursts (RPBs - sequences of unipolar pulses believed to be produced before a return stroke) in the waveforms of integrated magnetic field B. Each burst contains several tens of pulses, each having a width of a few microseconds and an inter-pulse interval of 4 -7 microseconds. We have also found several

  20. A Comparative Study on the Positive Lightning Return Stroke Electric Fields in Different Meteorological Conditions

    Directory of Open Access Journals (Sweden)

    Chin-Leong Wooi

    2015-01-01

    Full Text Available Positive cloud-ground lightning is considerably more complex and less studied compared to the negative lightning. This paper aims to measure and characterize the significant parameters of positive return strokes electric field, namely, the zero-to-peak rise time, 10–90% rise time, slow front duration, fast transition rise time (10–90%, zero-crossing time, and opposite polarity overshoot relative to peak. To the best of the authors’ knowledge, this is the first time such detailed characteristics of positive lightning in Malaysia are thoroughly analyzed. A total of 41 positive lightning flashes containing 48 return strokes were analyzed. The average multiplicity is 1.2 strokes per flash. The majority of positive lightning was initiated from the primary positive charge rather than as a byproduct of in-cloud discharges. The cumulative probability distribution of rise time parameters, opposite polarity overshoot relative to peak, and slow front amplitude relative to peak are presented. A comparison between studies in four countries representing tropic, subtropic, and temperate regions was also carried out. Measured parameters in Florida, Sweden, and Japan are generally lower than those in Malaysia. Positive lightning occurrences in tropical regions should be further studied and analyzed to improve our current understanding on positive return strokes.

  1. The influence of psychiatric morbidity on return to paid work after stroke in younger adults: the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003.

    Science.gov (United States)

    Glozier, Nick; Hackett, Maree L; Parag, Varsha; Anderson, Craig S

    2008-05-01

    Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person's mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors. The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39; 95% CI 0.22 to 0.80). Non-New Zealand European ethnicity (OR 0.40; 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work. About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.

  2. When Does Return of Voluntary Finger Extension Occur Post-Stroke? A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Caroline Winters

    Full Text Available Patients without voluntary finger extension early post-stroke are suggested to have a poor prognosis for regaining upper limb capacity at 6 months. Despite this poor prognosis, a number of patients do regain upper limb capacity. We aimed to determine the time window for return of voluntary finger extension during motor recovery and identify clinical characteristics of patients who, despite an initially poor prognosis, show upper limb capacity at 6 months post-stroke.Survival analysis was used to assess the time window for return of voluntary finger extension (Fugl-Meyer Assessment hand sub item finger extension≥1. A cut-off of ≥10 points on the Action Research Arm Test was used to define return of some upper limb capacity (i.e. ability to pick up a small object. Probabilities for regaining upper limb capacity at 6 months post-stroke were determined with multivariable logistic regression analysis using patient characteristics.45 of the 100 patients without voluntary finger extension at 8 ± 4 days post-stroke achieved an Action Research Arm Test score of ≥10 points at 6 months. The median time for regaining voluntary finger extension for these recoverers was 4 weeks (lower and upper percentile respectively 2 and 8 weeks. The median time to return of VFE was not reached for the whole group (N = 100. Patients who had moderate to good lower limb function (Motricity Index leg≥35 points, no visuospatial neglect (single-letter cancellation test asymmetry between the contralesional and ipsilesional sides of <2 omissions and sufficient somatosensory function (Erasmus MC modified Nottingham Sensory Assessment≥33 points had a 0.94 probability of regaining upper limb capacity at 6 months post-stroke.We recommend weekly monitoring of voluntary finger extension within the first 4 weeks post-stroke and preferably up to 8 weeks. Patients with paresis mainly restricted to the upper limb, no visuospatial neglect and sufficient somatosensory function are

  3. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  4. Successful integration of fast track projects into turnarounds

    Energy Technology Data Exchange (ETDEWEB)

    Williams, J. Patrick; Loureiro, Ramon C. [KBC Advanced Technologies, Surrey (United Kingdom)

    2012-07-01

    Fast track projects can provide quick wins and competitive advantage. However, in most cases the implementation of these projects requires a shutdown for installing the necessary tie-ins or integration into an upcoming turnaround (TA). Depending on the nature of the project and complexity of the TA, the integration can be seamless or result in cost or duration overruns and safety incidents. The risk of such overruns and safety incidents increases with the amount of project work to be integrated into the operations, maintenance and inspection schedules to be executed during the TA. The risk further increases with TA size and other factors. If not planned and scheduled properly and in a timely fashion, capital projects, in particular fast track projects trying to take advantage of an upcoming TA, can severely impact both TA performance, and the safety and reliability of the facility until the next opportunity for eliminating the defects introduced during the TA. Successful TAs are those delivered in a safe, on time, on budget manner, and with the quality standards needed for a leak-free start-up and a safe and reliable operation over the next run cycle. This paper discusses the key elements that are required to minimize the TA risks derived from the inclusion of fast track projects and how to establish the cut off criteria to either cancel or defer the project, or delay the TA in order to balance TA scope freeze and the case for compelling economics.(author)

  5. Activity, Sleep and Cognition After Fast-Track Hip or Knee Arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Jennum, Poul; Kehlet, Henrik

    2013-01-01

    postoperatively with actigraphs for sleep and activity assessment. Pain scores were recorded daily. Cognition was evaluated by 2 cognitive tests. Results showed a mean age was 70.5years and mean LOS was 2.6days. Actigraphs showed increased daytime sleep and decreased motor activity postoperatively. Early......Optimized perioperative care after total hip and knee arthroplasty (THA/TKA) has decreased length of stay (LOS) but data on activity, sleep and cognition after discharge are limited. We included 20 patients ≥60years undergoing THA/TKA, monitoring them for 3days preoperatively and 9days...... postoperatively cognitive decline and increased pain returned to preoperative levels by postoperative day (POD) 5-9. Despite the small sample size the study illustrated that post-discharge activity is decreased and daytime sleep is increased after fast-track THA/TKA, while cognition and pain return...

  6. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-08-01

    Full Text Available The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program, where improved healing process is particularly useful to comorbid patients.

  7. Environmental Impact Assessment of Kathmandu Terai Fast-Track

    Directory of Open Access Journals (Sweden)

    Padam Kanta Dahal

    2014-12-01

    Full Text Available  Road transport is dominant necessity for the overall economic development of any nation. In case of Nepal, an easy access between the Capital City and Terai, the store-house of the country and is very necessary. To facilitate this promotion of an improved core road network, Government of Nepal has launched the Kathmandu Terai Fast Track Project. Many concerned personalities and sectors had considered this project to be number one in the list of seventeen projects of national pride declared by the government. The main objective of this study was to identify the impacts of proposed project implementation on physical, biological, socio-economic and cultural environment of the project area and propose mitigation measures to avoid or mitigate such impacts. Primary information collection and secondary data review was the source of data with cross sectional descriptive study design. Data was taken purposively in the project affected area. Length of 72.6 km fast track from Kathmandu – Lalitpur – Makawanpur and up to Nijgadh in Bara district to link with the East West Highway will be of four lanes with 50 m on each side. The project was proposed to have 96 bridges big or small; 1.6 km long tunnel will be built in Thingan of Makawanpur on public-private partnership. It had projected costs of more than NRs 250 million. The impacts on land use will be on about 30km of agricultural land, 43km of forests and about 3km of other land uses, bridges etc. in the main alignment. The impacts on human life will mainly be in villages near the alignment. There are 38 villages within about 50m of the main alignment. The project can be continued with minimum of environmental degradation by applying the mitigation measures. Nation has been investing a lot of resources. Upon the completion of the fast track, the distance and time to reach the capital city from Terai will come down to only 1.5 hours and will transform the capital, eastern Terai and the country as a

  8. Fast-track video-assisted thoracoscopic surgery

    DEFF Research Database (Denmark)

    Holbek, Bo Laksafoss; Petersen, René Horsleben; Kehlet, Henrik

    2016-01-01

    -assisted thoracoscopic surgery (RATS), robotic, thoracotomy, single-incision, uniportal, natural orifice transluminal endoscopic surgery (NOTES), chest tube, air-leak, digital drainage, pain management, analgesia, perioperative management, anaesthesia and non-intubated. References from articles were screened for further...... articles. Using abstracts, areas of interest for developing a fast-track protocol were selected. Results The minimally invasive approach can be divided into several surgical methods that need further research to establish superiority. The role of intubation has to be further examined as well as the role...

  9. Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

    Directory of Open Access Journals (Sweden)

    Stefan K. Burgdorf

    2012-01-01

    Full Text Available Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation, but without changing nurse staffing or principles for peri- or postoperative care, that is, without implementing fast track principles, on length of stay after colorectal resection for cancer. Methods. Records of all patients operated for colorectal cancer from November 2004 to December 2008 in our department were reviewed. No specific patients were selected for laparoscopic repair, which was solely dependent on the presence of two specific surgeons at the same time. Thus, the patients were not selected for laparoscopic repair based on patient-related factors, but only on the simultaneous presence of two specific surgeons on the day of the operation. Results. Of a total of 540 included patients, 213 (39% were operated by a laparoscopic approach. The median hospital stay for patients with a primary anastomosis was significantly shorter after laparoscopic than after conventional open surgery (5 versus 8 days, while there was no difference in patients receiving a stoma (10 versus 10 days, ns, with no changes in the perioperative care regimens. Furthermore there were significant lower blood loss (50 versus 200 mL, and lower complication rate (21% versus 32%, in the laparoscopic group. Conclusion. Implementing laparoscopic colorectal surgery in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we

  10. Second Generation of a Fast-track Liver Resection Programme

    DEFF Research Database (Denmark)

    Schultz, Nicolai A; Larsen, Peter N; Klarskov, B

    2018-01-01

    was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently......BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over...

  11. On the electromagnetic fields, Poynting vector, and peak power radiated by lightning return strokes

    Science.gov (United States)

    Krider, E. P.

    1992-01-01

    The initial radiation fields, Poynting vector, and total electromagnetic power that a vertical return stroke radiates into the upper half space have been computed when the speed of the stroke, nu, is a significant fraction of the speed of light, c, assuming that at large distances and early times the source is an infinitesimal dipole. The initial current is also assumed to satisfy the transmission-line model with a constant nu and to be perpendicular to an infinite, perfectly conducting ground. The effect of a large nu is to increase the radiation fields by a factor of (1-beta-sq cos-sq theta) exp -1, where beta = nu/c and theta is measured from the vertical, and the Poynting vector by a factor of (1-beta-sq cos-sq theta) exp -2.

  12. Point of no return in diving emperor penguins: is the timing of the decision to return limited by the number of strokes?

    Science.gov (United States)

    Shiomi, Kozue; Sato, Katsufumi; Ponganis, Paul J

    2012-01-01

    At some point in a dive, breath-hold divers must decide to return to the surface to breathe. The issue of when to end a dive has been discussed intensively in terms of foraging ecology and behavioral physiology, using dive duration as a temporal parameter. Inevitably, however, a time lag exists between the decision of animals to start returning to the surface and the end of the dive, especially in deep dives. In the present study, we examined the decision time in emperor penguins under two different conditions: during foraging trips at sea and during dives at an artificial isolated dive hole. It was found that there was an upper limit for the decision-to-return time irrespective of dive depth in birds diving at sea. However, in a large proportion of dives at the isolated dive hole, the decision-to-return time exceeded the upper limit at sea. This difference between the decision times in dives at sea versus the isolated dive hole was accounted for by a difference in stroke rate. The stroke rates were much lower in dives at the isolated hole and were inversely correlated with the upper limit of decision times in individual birds. Unlike the decision time to start returning, the cumulative number of strokes at the decision time fell within a similar range in the two experiments. This finding suggests that the number of strokes, but not elapsed time, constrained the decision of emperor penguins to return to the surface. While the decision to return and to end a dive may be determined by a variety of ecological, behavioral and physiological factors, the upper limit to that decision time may be related to cumulative muscle workload.

  13. Sleep disturbances after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, L; Jennum, P; Kehlet, H

    2012-01-01

    on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. CONCLUSIONS: /st>Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated......BACKGROUND: /st>Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement......, and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. RESULTS: /st>The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean...

  14. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore......AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from...... gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks. CONCLUSION: Nursing care...

  15. Early recovery after fast-track Oxford unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Dalsgaard, Jesper; Bjerggaard, Karin

    2012-01-01

    trauma. We investigated changes in leg-extension power (LEP) in the first month after MIS Oxford UKA and its relation to pain, knee motion, functional performance, and knee function. Patients and methods In 35 consecutive Oxford UKA patients, LEP was measured 1 week before and 1 month after surgery...... together with knee motion, knee swelling, the 30-second chair-stand test, and Oxford knee score. Assessment of knee pain at rest and walking was done using a visual analog scale. Results 30 patients were discharged on the day after surgery, and 5 on the second day after surgery. LEP and functional...... supervision in the first month after discharge. Interpretation Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used....

  16. Fast Tracking for the ATLAS LVL2 Trigger

    CERN Document Server

    Baines, J T M; Emeliyanov, D; Konstantinidis, N P; Parodi, F; Schiavi, C; Sutton, M; Computing In High Energy Physics

    2005-01-01

    We present a set of algorithms for fast track reconstruction at the second level (LVL2) trigger of ATLAS, using three-dimensional space points (= hits) from the silicon trackers. The strategy is to determine the position z_0 of the interesting pp interaction along the beam axis prior to any track reconstruction and then retain only groups of hits which point back to that z_0 and perform combinatorial tracking only inside those groups. We give results and discuss the advantages of this approach, which is generic enough to be applicable to other multi-collision experiments. We also make a qualitative comparison with a complementary approach which is based on Look-Up Tables (LUT) and is also used in ATLAS.

  17. The evolution of discharge current and channel radius in cloud-to-ground lightning return stroke process

    Science.gov (United States)

    Fan, Tingting; Yuan, Ping; Wang, Xuejuan; Cen, Jianyong; Chang, Xuan; Zhao, Yanyan

    2017-09-01

    The spectra of two negative cloud-to-ground lightning discharge processes with multi-return strokes are obtained by a slit-less high-speed spectrograph, which the temporal resolution is 110 μs. Combined with the synchronous electrical observation data and theoretical calculation, the physical characteristics during return strokes process are analysed. A positive correlation between discharge current and intensity of ionic lines in the spectra is verified, and based on this feature, the current evolution characteristics during four return strokes are investigated. The results show that the time from peak current to the half-peak value estimated by multi point-fitting is about 101 μs-139 μs. The Joule heat in per unit length of four return strokes channel is in the order of 105J/m-106 J/m. The radius of arc discharge channel is positively related to the discharge current, and the more intense the current is, the greater the radius of channel is. Furthermore, the evolution for radius of arc core channel in the process of return stroke is consistent with the change trend of discharge current after the peak value. Compared with the decay of the current, the temperature decreases more slowly.

  18. On Practical Implementation of Electromagnetic Models of Lightning Return-Strokes

    Directory of Open Access Journals (Sweden)

    Hamidreza Karami

    2016-10-01

    Full Text Available In electromagnetic models, the return-stroke channel is represented as an antenna excited at its base by either a voltage or a current source. To adjust the speed of the current pulse propagating in the channel to available optical observations, different representations for the return-stroke channel have been proposed in the literature using different techniques to artificially reduce the propagation speed of the current pulse to values consistent with observations. In this paper, we present an analysis of the available electromagnetic models in terms of their practical implementation. Criteria used for the analysis are the ease of implementation of the models, the numerical accuracy and the needed computer resources, as well as their ability to reproduce a desired value for the speed of the return stroke current pulse. Using the CST-MWS software, which is based on the time-domain finite-integration technique, different electromagnetic models were analyzed, namely (A a wire embedded in a fictitious half-space dielectric medium (other than air, (B a wire embedded in a fictitious coating with permittivity (εr and permeability (μr, and (C a wire in free-space loaded by distributed series inductance and resistance. It is shown that, by adjusting the parameters of each model, it is possible to reproduce a desired value for the speed of the current pulse. For each of the considered models, we determined the values for the adjustable parameters that allow obtaining the desired value of the return speed. Model A is the least expensive in terms of computing resources. However, it requires two simulation runs to obtain the electromagnetic fields. A variant of Model B that includes a fictitious dielectric/ferromagnetic coating is found to be more efficient to control the current speed along the channel than using only a dielectric coating. On the other hand, this model requires an increased number of mesh cells, resulting in higher memory and

  19. Triggered lightning return stroke luminosity to 1 km in two optical bands

    Science.gov (United States)

    Carvalho, F. L.; Uman, M. A.; Jordan, D. M.; Wilkes, R.; Kotovsky, D. A.; Hare, B.

    2017-12-01

    Measured luminosity waveforms are presented and analyzed as a function of time and channel height using two types of avalanche photodiodes (APDs) for 19 triggered-lightning return strokes during summer 2016. APD type I had an optical bandwidth from 200 nm to 1,000 nm, with peak response at 600 nm (green light), and APD type II had an optical bandwidth from 400 nm to 1,000 nm with a peak response at 800 nm (red light). Ten channel heights ranging from 0 to 1 km (in 100 m increments) were observed by both types of APDs, 20 total, and measured the luminosity in vertical channel slices of approximately 3 m. For APD type I, the return stroke luminosity waveforms generally decay faster following its singular initial peak (IP) than the waveforms recorded by APD type II. APD type II waveforms often exhibit a second maxima (SM) following the IP. Although the wave shapes recorded by each APD type diverge after the IP, the risetime of the initial luminosity wave front preceding the IP for both types of APDs agrees well. The divergence in the luminosity wave shapes following the IP indicates that APD type II is capable of recording spectral lines that are excited or enhanced after the IP more effectively than APD type I. In addition, the SM/IP ratio increases as a function of channel height, indicating that the spectral range better captured by APD type II is more predominant at the top of the channel than at the bottom. Finally, because APD type II responds better to longer wavelengths than APD type I, and because the SM occurs a few microseconds after the IP (at the channel-bottom), we conjecture that the SM following the IP is a consequence of spectral lines excited during the cooling of the channel, following the initial high-temperature/pressure stage. Our data suggests that the initial optical radiation during the return stroke is dominated by ionized atomic species (e.g. four NII lines between 450 and 600 nm, better captured by APD type I) radiated at higher

  20. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surge...

  1. Implementation of the scientific evidence into daily practice - example from fast-track colonic cancer surgery

    DEFF Research Database (Denmark)

    Hammer, J.; Harling, H.; Wille-Jorgensen, P.

    2008-01-01

    Objective To report the implementation and results of fast-track surgery for colonic cancer in the daily routine. Method A total of 131 consecutive patients scheduled for elective colonic cancer resections entered a fast-track perioperative course after thorough information. The regimen contained...

  2. Which fast track elements predict early recovery after colon cancer surgery?

    NARCIS (Netherlands)

    Vlug, M. S.; Bartels, S. A. L.; Wind, J.; Ubbink, D. T.; Hollmann, M. W.; Bemelman, W. A.; Sprangers, Mirjam; Preckel, Benedikt; Bossuyt, Patrick; Gouma, Dirk; van Berge Henegouwen, Mark; Fuhring, Jan; Lenthe, Ineke Picard-van; Bakker, Chris; King-Kalimanis, Bellinda; Hofland, Jan; Dejong, Cornelis; van Dam, Ronald; Cuesta, Miguel; van der Peet, Donald; van Zalingen, Edith; Noordhuis, Astrid; de Jong, Dick; Engel, Alexander; Goei, T. Hauwy; de Stoppelaar, Erica; van den Dongen, Marjon; van Wagensveld, Bart; van Tets, Willem; van den Elsen, Maarten; Swart, Annemiek; Gerhards, Michael; de Wit, Laurens; Siepel, Muriel; Molly, Glaresa; Gasthuis, Onze Lieve Vrouwe; van Geloven, Anna; Juttmann, Jan; Clevers, Wilfred; Bieleman, Andrea; van der Zaag, Edwin; Coenen, Ludo; Bonekamp, Elly; Cense, Huib; van Abeelen, Jacobus; van Iterson-de Jong, Diana; Krombeen, Margriet

    2012-01-01

    Aim It is questioned whether all separate fast track elements are essential for enhanced postoperative recovery. We aimed to determine which baseline characteristics and which fast track elements are independent predictors of faster postoperative recovery in patients undergoing resection for colon

  3. Fast Track Surgery at the University Teaching Hospital of Kigali: A ...

    African Journals Online (AJOL)

    ADMIN

    ... Fast Track Surgery, hospital stay, mobilization, beneficial effects, Randomised control trial. Introduction. Fast-track surgery (FTS) was initiated by the Danish surgeon H Kehlet in the field of elective colorectal surgery in the 1990s 1, 2, and has rapidly gained popularity around the world because of its significant benefits and ...

  4. ["Fast-track" and elective, laparoscopic colo-rectal surgery].

    Science.gov (United States)

    Widmaier, U; Karrer, M; Schoenberg, M H

    2007-08-01

    The aim of this prospective clinical evaluation was to investigate the influence of "Fast-track"-treatment in patients undergoing laparoscopic colorectal operations and its effect on morbidity, hospital stay and recovery. Bowel cleaning under enteral hypercaloric nutrition (Biosorb Energie, Fa. Nutricia, Germany) was achieved with Fleet (Ferring Arzneimittel, Germany) one day prior to surgery. A peridural catheter was placed preoperatively. Intraoperative electrolyte substitution should not exceed 12 ml/kg KG/h. In case of decreasing intraoperative blood pressure hydroxyethylstarch 6% was substituted. The nasogastric tube was removed immediately after the operation, the urinary catheter was removed on the first postoperative day. The patients stayed on the intermediate care department for one night and started already there with oral feeding and mobilisation (for 2 h). The following days mobilisation increased to 4 h daily under normal enteral nutrition without infusions. Between June 2003 and January 2006, 147 patients undergoing elective colorectal surgery were included in this study. Diverticulitis (n = 114), malignant tumors of the sigmoid colon (n = 6) or rectal cancer (n = 13), colonic adenomas (n = 5), stenotic Crohn's disease (n = 4) and small bowel carcinoid (n = 1), rectal prolaps (n = 1) and elongated colon sigmoideum (n = 4) were indications for surgical treatment. Laparoscopic sigmoid resection (n = 117), left hemicolectomy (n = 11), ileocecal resection (n = 8), anterior resection with total mesorectal excision (n = 9), abdomino-perineal exstirpation (n = 1) and anterior-segmental resection of the rectum (n = 1) were performed. Drainages were removed on the 2nd, peridural catheter on the 3rd postoperative day. Defecation occurred in all patients until the 2 (nd) postop. day. Early postoperative complication rate was 15% (22/147 patients) without mortality. 8 patients (5%) with anastomotic leakage were reoperated. The mean hospital stay was 6 days. The

  5. Simulation of radiation from lightning return strokes - The effects of tortuosity

    Science.gov (United States)

    Levine, D. M.; Meneghini, R.

    1978-01-01

    A Monte Carlo simulation has been developed for the electromagnetic fields radiated from a tortuous lightning channel. This was done using a piecewise linear model for the channel and employing for each element the field radiated by a traveling wave on an arbitrarily oriented filament over a conducting plane. The simulation reproduces experimental data reasonably well and has been used to study the effects of tortuosity on the fields radiated by return strokes. Tortuosity can significantly modify the radiated waveform, tending to render it less representative of the current pulse and more nearly unipolar than one would expect based on the theory for a long straight channel. In the frequency domain the effect of tortuosity is an increase in high frequency energy as compared with an equivalent straight channel. The extent of this increase depends on the mean length of the elements comprising the channel and can be significant.

  6. Simulation of radiation from lightning return strokes: The effects of tortuosity

    Science.gov (United States)

    Levine, D. M.; Meneghini, R.

    1977-01-01

    A Monte Carlo simulation has been developed for the electromagnetic fields radiated from a tortuous lightning channel. This was done using a piecewise linear model for the channel and employing for each element the field radiated by a traveling wave on an arbitrarily oriented filament over a conducting plane. The simulation reproduces experimental data reasonably well and had been used to study the effects of tortuousity on the fields radiated by return strokes. Tortuosity can significantly modify the radiated waveform, tending to render it less representative of the current pulse and more nearly unipolar than one would expect based on the theory for a long straight channel. In the frequency domain the effect of tortuosity is an increase in high frequency energy as compared with an equivalent straight channel. The extent of this increase depends on the mean length of the elements comprising the channel and can be significant.

  7. Electromagnetic fields radiated from a lightning return stroke - Application of an exact solution to Maxwell's equations

    Science.gov (United States)

    Le Vine, D. M.; Meneghini, R.

    1978-01-01

    A solution is presented for the electromagnetic fields radiated by an arbitrarily oriented current filament over a conducting ground plane in the case where the current propagates along the filament at the speed of light, and this solution is interpreted in terms of radiation from lightning return strokes. The solution is exact in the fullest sense; no mathematical approximations are made, and the governing differential equations and boundary conditions are satisfied. The solution has the additional attribute of being specified in closed form in terms of elementary functions. This solution is discussed from the point of view of deducing lightning current wave forms from measurements of the electromagnetic fields and understanding the effects of channel tortuosity on the radiated fields. In addition, it is compared with two approximate solutions, the traditional moment approximation and the Fraunhofer approximation, and a set of criteria describing their applicability are presented and interpreted.

  8. Fast-track aquifer characterization and bioremediation of groundwater

    International Nuclear Information System (INIS)

    Owen, S.B.; Erskine, J.A.; Adkisson, C.

    1995-01-01

    A short duration step-drawdown pumping test has been used to characterize a highly permeable aquifer contaminated with petroleum hydrocarbons in support of an in situ, closed loop extraction and reinjection bioremediation system for groundwater. The short-term pumping test produces a manageable quantity of contaminated groundwater while yielding a range of values for transmissivity and specific yield parameters. This range of aquifer coefficients is used in an analytical model to estimate a range of groundwater extraction rates that provide a suitable radius of influence for the extraction and reinjection system. A multi-enzyme complex catalyzed bioremediation process has been used to aerobically degrade petroleum hydrocarbons. Enzymes, amino acids, and biosurfactants are supplied to the extracted groundwater to significantly speed up the degradation by naturally occurring bacteria. During the process, amino acids promote the rapid growth of the microbial population while enzymes and bacteria attach to hydrocarbons forming a transformation state complex that degrades to fatty acids, carbon dioxide, and water. This paper presents a case study of a fast-track bioremediation using pumping test data, analytical modeling, and an enzyme technology

  9. Orchestrating care through the fast-track perspective: A qualitative content analysis of the provision of individualised nursing care in orthopaedic fast-track programmes.

    Science.gov (United States)

    Berthelsen, Connie Bøttcher; Frederiksen, Kirsten

    2017-02-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion criteria to maintain the effective elements in the programme and to facilitate nurses' opportunities to offer individual care, thereby ensuring that fragile patients have access to other possibilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surge......Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type...... of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section......, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements...

  11. The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Wied, Christian; Thomsen, Morten G; Kallemose, Thomas

    2015-01-01

    BACKGROUND: Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track...

  12. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira

    2017-01-01

    BACKGROUND: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast......-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare...... this between 2 departments with different logistical set-ups. METHODS: Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish...

  13. When is it optimal to delegate: the theory of fast-track authority

    Czech Academy of Sciences Publication Activity Database

    Celik, Levent; Karabay, B.; McLaren, J.

    2015-01-01

    Roč. 7, č. 3 (2015), s. 347-389 ISSN 1945-7669 Institutional support: RVO:67985998 Keywords : fast-track authority * free trade * protectionist rents Subject RIV: AH - Economics Impact factor: 1.359, year: 2015

  14. Stroke Volume During Concomitant Apnea and Exercise: Influence of Gravity and Venous Return

    Science.gov (United States)

    Hoffmann, Uwe; Drager, Tobias; Steegmanns, Ansgar; Koesterer, Thomas; Linnarsson, Dag

    2008-06-01

    The responses of the cardiovascular system to intensive exercise (hiP) and combined stimuli by hiP and breath-hold (hiP-BH) for 20 s were examined during changing gravity (parabolic flight) and constant gravity (1g). The basic response to microgravity (μg) during low-intensity exercise was an increase in cardiac output (CO) and stroke volume (SV) as a result of augmented venous return. When onset of hiP was superimposed, the initial augmentation of CO and SV were increased further. In contrast, when BH was added, the increases of CO and SV were slowed. We propose that this was due to a transient increase of the pulmonary blood volume with the combination of μg and BH at large lung volume, creating a temporary imbalance between right ventricular input and left ventricular output. In addition, the BH- induced relative bradycardia may have contributed to a prolongation of the right-to- left indirect ventricular interdependence.

  15. Restoring integrity--A grounded theory of coping with a fast track surgery programme.

    Science.gov (United States)

    Jørgensen, Lene Bastrup; Fridlund, Bengt

    2016-01-01

    The aim of this study was to generate a theory conceptualizing and explaining behavioural processes involved in coping in order to identify the predominant coping types and coping type-specific features. Patients undergoing fast track procedures do not experience a higher risk of complications, readmission, or mortality. However, such programmes presuppose an increasing degree of patient involvement, placing high educational, physical, and mental demands on the patients. There is a lack of knowledge about how patients understand and cope with fast track programmes. The study design used classical grounded theory. The study used a multimodal approach with qualitative and quantitative data sets from 14 patients. Four predominant types of coping, with distinct physiological, cognitive, affective, and psychosocial features, existed among patients going through a fast track total hip replacement programme. These patients' main concern was to restore their physical and psychosocial integrity, which had been compromised by reduced function and mobility in daily life. To restore integrity they economized their mental resources, while striving to fulfil the expectations of the fast track programme. This goal was achieved by being mentally proactive and physically active. Three out of the four predominant types of coping matched the expectations expressed in the fast track programme. The non-matching behaviour was seen among the most nervous patients, who claimed the right to diverge from the programme. In theory, four predominant types of coping with distinct physiological, cognitive, affective, and psychosocial features occur among patients going through a fast track total hip arthroplasty programme.

  16. The Deep Physics Hidden within the Field Expressions of the Radiation Fields of Lightning Return Strokes

    Directory of Open Access Journals (Sweden)

    Vernon Cooray

    2016-01-01

    Full Text Available Based on the electromagnetic fields generated by a current pulse propagating from one point in space to another, a scenario that is frequently used to simulate return strokes in lightning flashes, it is shown that there is a deep physical connection between the electromagnetic energy dissipated by the system, the time over which this energy is dissipated and the charge associated with the current. For a given current pulse, the product of the energy dissipated and the time over which this energy is dissipated, defined as action in this paper, depends on the length of the channel, or the path, through which the current pulse is propagating. As the length of the channel varies, the action plotted against the length of the channel exhibits a maximum value. The location of the maximum value depends on the ratio of the length of the channel to the characteristic length of the current pulse. The latter is defined as the product of the duration of the current pulse and the speed of propagation of the current pulse. The magnitude of this maximum depends on the charge associated with the current pulse. The results show that when the charge associated with the current pulse approaches the electronic charge, the value of this maximum reaches a value close to h/8π where h is the Plank constant. From this result, one can deduce that the time-energy uncertainty principle is the reason for the fact that the smallest charge that can be detected from the electromagnetic radiation is equal to the electronic charge. Since any system that generates electromagnetic radiation can be represented by a current pulse propagating from one point in space to another, the result is deemed valid for electromagnetic radiation fields in general.

  17. Prospective randomized controlled trial to evaluate "fast-track" elective open infrarenal aneurysm repair.

    Science.gov (United States)

    Muehling, Bernd M; Halter, Gisela; Lang, Gunter; Schelzig, Hubert; Steffen, Peter; Wagner, Florian; Meierhenrich, Rainer; Sunder-Plassmann, Ludger; Orend, Karl-Heinz

    2008-05-01

    Fast-track programs have been introduced in many surgical fields to minimize postoperative morbidity and mortality. Morbidity after elective open infrarenal aneurysm repair is as high as 30%; mortality ranges up to 10%. In terms of open infrarenal aneurysm repair, no randomized controlled trials exist to introduce and evaluate such patient care programs. This study involved prospective randomization of 82 patients in a "traditional" and a "fast-track" treatment arm. Main differences consisted in preoperative bowel washout (none vs. 3 l cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia). Study endpoints were morbidity and mortality, need for postoperative mechanical ventilation, and length of stay (LOS) on intensive care unit (ICU). The need for assisted postoperative ventilation was significantly higher in the traditional group (33.3% vs. 5.4%; p = 0.011). Median LOS on ICU was shorter in the fast-track group, 41 vs. 20 h. The rate of postoperative medical complications was significantly lower in the fast-track group, 16.2% vs. 35.7% (p = 0.045). We introduced and evaluated an optimized patient care program for patients undergoing open infrarenal aortic aneurysm repair which showed a significant advantage for "fast-track" patients in terms of postoperative morbidity.

  18. Safety of fast track surgery in pancreaticoduodenectomy: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    LI Weinan

    2017-01-01

    Full Text Available ObjectiveTo investigate the safety and clinical effect of fast track surgery in pancreaticoduodenectomy, one of the most complex surgeries in general surgery. MethodsThe Chinese and foreign databases were searched for articles on the application of fast tract surgery in pancreaticoduodenectomy published from January 1994 to April 2016. Two researchers evaluated the quality of the articles which met the inclusion criteria and extracted related data. Stata 12.0 software was used to analyze the overall incidence rate of complications and the incidence rates of pancreatic leakage and gastrointestinal emptying disorder, and the Begg rank correlation test and Egger linear regression method were used to investigate publication bias. ResultsThe fast track surgery group had a significantly lower overall incidence rate of complications than the conventional group (RR=0.748, 95%CI: 0.680-0.824, P<0.001. There was no significant difference in the incidence rate of pancreatic leakage between the two groups (RR=0.894, 95%CI:0.734-1.089, P=0.266. The fast track surgery group had a significantly lower incidence rate of gastrointestinal emptying disorder than the conventional group (RR=0.520, 95%CI:0.400-0.670, P<0.001. ConclusionFast track surgery is safe and effective in pancreaticoduodenectomy, but the application of some measures in fast track surgery still needs more medical evidence.

  19. Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia

    DEFF Research Database (Denmark)

    Khanykin, Boris; Siddiqi, Rizwan; Jensen, Per F

    2013-01-01

    BACKGROUND: Different anesthetic techniques have been used for fast tracking in cardiac anesthesia. Remifentanil, with its unique pharmacokinetic profile, could be an ideal drug for fast tracking. Possible limitations of remifentanil are rapid onset of postoperative pain after discontinuation...... of the drug infusion, which may increase the risk of an ischemic event. We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia. It has been hypothesized that remifentanil would provide a safe anesthesia with no impact...... anesthesia. The study was designed as a prospective randomized study. The primary outcomes were changes in the cardiac index and creatine kinase MB fraction (CKMB), extubation times, mobilization times, and lengths of stay in the intensive care unit (ICU) and the hospital. Frequency of myocardial infarction...

  20. Maintaining Unity - Relatives in older patient's fast-track treatment programmes. A Grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

    2014-01-01

    AIM: To generate a substantive grounded theory of relatives' pattern of behaviour in older patients' fast-track treatment programmes during total hip or knee replacement. BACKGROUND: Fast-track treatment programmes are designed to make total hip and knee replacements more efficient through recovery...... improvements. The support of relatives during older patients' trajectory is important. However, knowledge is needed on the relatives' pattern of behaviour to strengthen their involvement in fast-track treatment programmes. DESIGN: We used a Glaserian grounded theory approach based on a systematic generation...... of theory from data to explain the latent pattern of behaviour of relatives. METHODS: Data were collected from 2010-2011 in orthopaedic wards at two Danish university hospitals and consisted of 14 non-participant observations, 14 postobservational interviews and five interviews. Seven relatives of patients...

  1. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    BACKGROUND AND PURPOSE: Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding...... length of stay (LOS) and patient satisfaction. PATIENTS AND METHODS: In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient...... comorbidity, or LOS. THR patients had shorter mean LOS than TKR patients, even though the median LOS was 2 days for both groups. THR patients were more satisfied than TKR patients in the first weeks after discharge. INTERPRETATION: Patient satisfaction is high following fast-track THR and TKR, with scores...

  2. Fast track diagnosis as a means of reducing diagnostic delay in cancer

    DEFF Research Database (Denmark)

    Larsen, Mette Bach; Vedsted, Peter; Olesen, Frede

    of cancer and expanded services to the general practitioners. Objective: To investigate the diagnostic delay of cancer, patient and provider satisfaction and health economic aspects in two Danish regions with special emphasis on the possible benefits of fast track diagnosis. Methods: The study...... in diagnostic delay will be described in uni- and multivariate analysis models based on three types of delay (patient, doctors and system delay) and stratified by diagnosis. The second part of the analysis will focus on the possible benefits from fast track diagnosis in terms of reduced diagnostic delay......Background: Denmark has the highest morbidity and mortality from cancer in Western Europe, and studies suggest that Danish cancer patients are diagnosed at a later stage than patients in the other Nordic countries. To address this issue a Danish hospital has introduced fast track diagnosis...

  3. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer

    DEFF Research Database (Denmark)

    Stottmeier, S; Harling, H; Wille-Jørgensen, Peer Anders

    2012-01-01

    Aim: Analysis was carried out of the nature and chronological order of early complications after fast-track laparoscopic rectal surgery with a view to optimize the short-time outcome of rectal cancer surgery. Method: 102 consecutive patients who underwent elective fast-track laparoscopic rectal...... cancer surgery were analysed prospectively from the Danish Colorectal Cancer Database supplemented by data from the medical records. We studied in detail the nature and chronological order of postoperative morbidity and reason for prolonged stay (>5 days). Results: Twenty-five patients (25 per cent) had...

  4. Convalescence after colonic resection with fast-track versus conventional care

    DEFF Research Database (Denmark)

    Hjort Jakobsen, D; Sonne, E; Basse, L

    2004-01-01

    BACKGROUND: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. AIM: The objectives were to compare convalescence data (fatigue, sleep...... vs. 8 days in the fast-track vs. conventional care group, respectively (p sleep were increased in the conventional care group when compared with the fast-track group (p ... results in earlier resumption of normal activities with reduced fatigue and need for sleep postoperatively compared to conventional care, and without increased need for nursing care or visits to general practitioners. However, readmissions may occur more frequently....

  5. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jørgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length o...

  6. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, O; Bundgaard-Nielsen, M; Solgaard, S

    2012-01-01

    BACKGROUND: /st>Early postoperative mobilization is a cornerstone in fast-track total hip arthroplasty (THA), but postoperative orthostatic intolerance (OI) may delay early recovery or lead to fainting, falls, and prosthesis dislocation or fracture. However, the prevalence and pathophysiology of OI...

  7. Fast-track IPP based on LM6000 gas turbines brings quick power to Ecuador

    Energy Technology Data Exchange (ETDEWEB)

    Pinder, Ron [GE Marine and Industrial Engines, Evendale, OH (United States); Garcia, Ernesto [Stewart and Stevenson International Inc., Coral Gables, FL (United States)

    1996-11-01

    With the country suffering from severe power shortages, the Ecuadorian government began a process of power sector liberalization, allowing private fast-track IPPs to construct much needed capacity. One of these crucial projects, the Electroquil power plant in Guayaquil, began operation in May this year. (author)

  8. Families' Divided: The place of the Family in Zimbabwe's Fast Track ...

    African Journals Online (AJOL)

    The political history and the political economy continue to mould the quality of life for most families in significant ways. Human beings have always lived in families from the beginning of time. The family is a pillar of society as it influences the way society is structured, organized and functions, yet the Fast Track Land Reform ...

  9. Subacute pain and function after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Gaarn-Larsen, L; Kristensen, B B

    2009-01-01

    study. The purpose was to describe the prevalence and intensity of subacute postoperative pain and opioid related side effects, use of analgesics and functional ability 1-10 and 30 days postoperatively. Fast-track total hip and knee arthroplasty with early discharge (

  10. The Effects of the Fast Track Preventive Intervention on the Development of Conduct Disorder across Childhood

    Science.gov (United States)

    Child Development, 2011

    2011-01-01

    The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social…

  11. Fast track surgery at the University Teaching Hospital of Kigali: a ...

    African Journals Online (AJOL)

    Background: Fast Track Surgery is synonymous with Enhanced Recovery after Surgery. It was started in the 1990's initially for colorectal surgery, but later became applicable to other aspects of surgery. Its core elements include epidural or regional anaesthesia, perioperative fluid management, minimally invasive surgical ...

  12. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis

    the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing...

  13. Physiotherapy Exercise After Fast-Track Total Hip and Knee Arthroplasty: Time for Reconsideration?

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Kehlet, Henrik

    2012-01-01

    not contain the right active ingredients (too little intensity) or is offered at the wrong time (too late after surgery). We propose changing the focus to earlier initiated and more intensive physiotherapy exercise after THA and TKA (fast-track physiotherapy exercise), to reduce the early loss of muscle...

  14. Fast-track surgery-an update on physiological care principles to enhance recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2011-01-01

    INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of mo...

  15. SMEs in Energy: Are they the parallel fast track for electrification of Africa?

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Rahman, Mohamed

    2010-09-15

    The African continent is suffering from a chronic energy shortage that hiders its development. The conventional wisdom is to put the Mega projects under focus. However, a parallel fast track for the energy as an SME business may bring faster results to the continent. To that end, this paper presents proposed steps to promote the concept within the continent.

  16. When is it optimal to delegate: the theory of fast-track authority

    Czech Academy of Sciences Publication Activity Database

    Celik, Levent; Karabay, Bilgehan; McLaren, J.

    2015-01-01

    Roč. 7, č. 3 (2015), s. 347-389 ISSN 1945-7669 R&D Projects: GA ČR(CZ) GAP402/12/0666 Institutional support: PRVOUK-P23 Keywords : fast-track authority * free trade * protectionist rents Subject RIV: AH - Economics Impact factor: 1.359, year: 2015

  17. Fast Tracking School Site Acquisition: A Perspective of an Eminent Domain Attorney.

    Science.gov (United States)

    Behrens, Jerry

    This paper discusses key issues in fast-tracking the acquisition of school sites in California. Discussion addresses: (1) assembling an experienced team; (2) whether the property owner is a willing or unwilling seller; (3) level of community support or opposition to the site; (4) timing and commencement of California Environmental Quality Act…

  18. A modified fast-track program for pancreatic surgery: a prospective single-center experience.

    Science.gov (United States)

    di Sebastiano, Pierluigi; Festa, Leonardina; De Bonis, Antonio; Ciuffreda, Andrea; Valvano, Maria Rosa; Andriulli, Angelo; di Mola, F Francesco

    2011-03-01

    The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders. The concept of fast-track surgery allowing accelerated postoperative recovery is accepted in colorectal surgery, but efficacy data are only preliminary for patients undergoing major pancreatic surgery. We aimed to evaluate the impact of a modified fast-track protocol in a high-volume center for patients with pancreatic disorders. Between February 2005 and January 2010, 145 subjects had resective pancreatic surgery and were enrolled in the program. Essential features of the program were no preanaesthetic medication, upper and lower air-warming device, avoidance of excessive i.v. fluids perioperatively, effective control of pain, early reinstitution of oral feeding, and immediate mobilization and restoration of bowel function following surgery. Outcome measures were postoperative complications such as pancreatic fistula, delayed gastric emptying, biliary leak, intra-abdominal abscess, post-pancreatectomy hemorrhage, acute pancreatitis, wound infection, 30-day mortality, postoperative hospital stay, and readmission rates. On average, patients were discharged on postoperative day 10 (range 6-69), with a 30-day readmission rate of 6.2%. Percentage of patients with at least one complication was 38.6%. Pancreatic anastomotic leakage occurred in seven of 101 pancreatico-jejunostomies, and biliary leak in three of 109 biliary jejunostomies. Postoperative hemorrhage occurred in ten (6.9%) patients and wound infection in nine (6.2%) cases. In-hospital mortality was 2.7%. Fast-track parameters, such as normal food and first stool, correlated significantly with early discharge (jaundice, and resumption of normal diet by the 5th postoperative day were independent factors of early discharge. Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreatic resection.

  19. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway.

    Science.gov (United States)

    Muehling, Bernd M; Halter, Gisela L; Schelzig, Hubert; Meierhenrich, Rainer; Steffen, Peter; Sunder-Plassmann, Ludger; Orend, Karl-Heinz

    2008-07-01

    Fast track programs, multimodal therapy strategies, have been introduced in many surgical fields to minimize postoperative morbidity and mortality. In terms of lung resections no randomized controlled trials exist to evaluate such patient care programs. In a prospective, randomized controlled pilot study a conservative and fast track treatment regimen in patients undergoing lung resections was compared. Main differences between the two groups consisted in preoperative fasting (6h vs 2h) and analgesia (patient controlled analgesia vs patient controlled epidural analgesia). Study endpoints were pulmonary complications (pneumonia, atelectasis, prolonged air leak), overall morbidity and mortality. Analysis was performed in an intention to treat. Both study groups were similar in terms of age, sex, preoperative forced expiratory volume in one second (FEV(1)), American Society of Anesthesiologists score and operations performed. The rate of postoperative pulmonary complications was 35% in the conservative and 6.6% in the fast track group (p=0.009). A subgroup of patients with reduced preoperative FEV(1) (<75% of predicted value) experienced less pulmonary complications in the fast track group (55% vs 7%, p=0.023). Overall morbidity was not significantly different (46% vs 26%, p=0.172), mortality was comparable in both groups (4% vs 3%). We evaluated an optimized patient care program for patients undergoing lung resections in a prospective randomized pilot study. Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery.

  20. Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study.

    Science.gov (United States)

    Aksel, Gokhan; Bildik, Fikret; Demircan, Ahmet; Keles, Ayfer; Kilicaslan, Isa; Guler, Sertac; Corbacioglu, Seref Kerem; Turkay, Asli; Bekgoz, Burak; Dogan, Nurettin Ozgur

    2014-07-01

    To determine the impact of a fast track area on emergency department crowding and its efficacy for non-urgent patients. The prospective cross-sectional study was conducted in an adult emergency department of a university-affiliated hospital in Turkey from September 17 to 30, 2010. Non-urgent patients were defined as those with Canadian Triage Acuity Scale category 4/5. The fast track area was open in the emergency department for one whole week, followed by another week in which fast track area was closed. Demographic information of patients, their complaints on admission, waiting times, length of stay and revisits were recorded. Overcrowding evaluation was performed via the National Emergency Department Overcrowding Study scale. In both weeks, the results of the patients were compared and the effects of fast track on the results were analysed. Continuous variables were compared via student's t test or Mann Whitney U test. Demographic features of the groups were evaluated by chi-square test. A total of 249 patients were seen during the fast track week, and 239 during the non-fast track week at the emergency department. Satisfaction level was higher in the fast track group than the non-fast track group (p overcrowding in the emergency department was lessened. It also improved effectiveness and quality measures.

  1. Early Progressive Strength Training to Enhance Recovery After Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Kehlet, Henrik; Husted, Henrik

    2014-01-01

    OBJECTIVE: To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. METHODS: In total, 82 patients with a unilateral primary TKA were randomized to 2...... different interventions: 7 weeks of supervised physical rehabilitation with PST (PST group) and without PST (CON group) commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower extremity strength and power......, knee joint effusion and range of motion, knee pain, and self-reported disability and quality of life. All outcome measures were assessed before TKA (baseline) and 4, 8, and 26 weeks after TKA. RESULTS: There was no statistically significant difference between the PST and CON groups in the change score...

  2. Convalescence after colonic resection with fast-track versus conventional care

    DEFF Research Database (Denmark)

    Hjort Jakobsen, D; Sonne, E; Basse, L

    2004-01-01

    undergoing fast-track rehabilitation with continuous epidural analgesia, enforced oral nutrition, mobilisation, planned early discharge, and 30 consecutive patients undergoing conventional care. Patients were interviewed preoperatively and 14 and 30 days postoperatively. RESULTS: Median hospital stay was 2......BACKGROUND: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. AIM: The objectives were to compare convalescence data (fatigue, sleep......, time to resume normal activities, and functional capabilities) and need for nursing care and contact to general practitioner with fast-track multi-modal rehabilitation compared with conventional care after colonic surgery. METHODS: Non-randomised, prospective controlled study in 30 consecutive patients...

  3. After colonic surgery: The lived experience of participating in a fast-track programme

    DEFF Research Database (Denmark)

    Norlyk, Annelise; Harder, Ingegerd

    2009-01-01

    Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience of partici......Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience......; but this role of being a good and cooperative patient had a built-in asymmetric power relationship favouring the professionals' expectations. The complexities of this power relationship were related to both patient factors and contextual factors, e.g. the daily regimen and hospital norms. Although patient...

  4. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis

    , pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking......  Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections...... the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing...

  5. Patient-reported outcome after fast-track hip arthroplasty: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Hansen Torben B

    2010-11-01

    Full Text Available Abstract Background A fast-track intervention with a short preoperative optimization period and short postoperative hospitalization has a potential for reduced convalescence and thereby a reduced need for postoperative rehabilitation. The purpose of this study was to describe patient-related outcomes, the need for additional rehabilitation after a fast-track total hip arthroplasty (THA, and the association between generic and disease specific outcomes. Methods The study consisted of 196 consecutive patients of which none received additional rehabilitation beyond an instructional exercise plan at discharge, which was adjusted at one in-patient visit. The patients filled in 3 questionnaires to measure health-related quality-of-life (HRQOL and hip specific function (EQ-5 D, SF36, and Harris Hip Score (HHS at 2 time points pre- and 2 time points postoperatively. The observed results were compared to normative population data for EQ-5 D, SF36, and HHS. Results 3-months postoperatively patients had reached a HRQOL level of 0.84 (SD, 0.14, which was similar to the population norm (P = 0.33, whereas they exceeded the population norm at 12 months postoperatively (P P P = 0.35. For HHS, patients never reached the population norm within 12 months postoperatively. Generic and disease specific outcomes were strongly associated. Conclusions If HRQOL is considered the primary outcome after THA, the need for additional postoperative rehabilitation for all THA patients following a fast-track intervention is questionable. However, a pre- or early postoperative physical intervention seems relevant if the PF of the population norm should be reached at 3 months. If disease specific outcome is considered the primary outcome after fast-track THA, clear goals for the rehabilitation must be established before patient selection, intervention type and timing of intervention can be made.

  6. A fast track path improves access to palliative care for people with learning disabilities.

    Science.gov (United States)

    Whitington, Jane; Ma, Peng

    People with learning disabilities often experience inequalities in accessing general health services. This group, their families and carers need access to effective palliative care when facing a life limiting illness. This article describes the development and implementation of a fast track referral pathway for people with learning disabilities at St Francis Hospice in Essex. Our aim is to share this pathway so others can replicate the collaborative working to improve access to palliative care services for this group.

  7. Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges

    DEFF Research Database (Denmark)

    Shewale, Jitesh B; Correa, Arlene M; Baker, Carla M

    2015-01-01

    OBJECTIVE: To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges. BACKGROUND: FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after...... = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P location. FTEP was also associated with a lower rate of pulmonary complications (odds ratio = 0...

  8. The Effects of the Fast Track Preventive Intervention on the Development of Conduct Disorder Across Childhood

    OpenAIRE

    2011-01-01

    The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes included psychiatric diagnoses after grades 3, 6, 9, and 12 for...

  9. A study on the influence of corona on currents and electromagnetic fields predicted by a nonlinear lightning return-stroke model

    Science.gov (United States)

    De Conti, Alberto; Silveira, Fernando H.; Visacro, Silvério

    2014-05-01

    This paper investigates the influence of corona on currents and electromagnetic fields predicted by a return-stroke model that represents the lightning channel as a nonuniform transmission line with time-varying (nonlinear) resistance. The corona model used in this paper allows the calculation of corona currents as a function of the radial electric field in the vicinity of the channel. A parametric study is presented to investigate the influence of corona parameters, such as the breakdown electric field and the critical electric field for the stable propagation of streamers, on predicted currents and electromagnetic fields. The results show that, regardless of the assumed corona parameters, the incorporation of corona into the nonuniform and nonlinear transmission line model under investigation modifies the model predictions so that they consistently reproduce most of the typical features of experimentally observed lightning electromagnetic fields and return-stroke speed profiles. In particular, it is shown that the proposed model leads to close vertical electric fields presenting waveforms, amplitudes, and decay with distance in good agreement with dart leader electric field changes measured in triggered lightning experiments. A comparison with popular engineering return-stroke models further confirms the model's ability to predict consistent electric field waveforms in the close vicinity of the channel. Some differences observed in the field amplitudes calculated with the different models can be related to the fact that current distortion, while present in the proposed model, is ultimately neglected in the considered engineering return-stroke models.

  10. Estimation of Sparkover Rate of Medium-Voltage Line due to Direct Lightning Hit Taking Account of Statistics on Observed Return-Stroke Current

    Science.gov (United States)

    Hongo, Yasuji; Michishita, Koji

    The overvoltage associated with direct lightning hits has been the important factor for the insulation design of a distribution line. In this paper, the sparkover rate of a medium-voltage line associated with direct lightning hits is investigated based on numerical calculations obtained by using EMTP and statistical analysis by taking account of the correlation between the peak value and the front duration of return-stroke current waveform. When the line is equipped with surge arresters at the interval of 100m in addition to the overhead ground wire, the sparkover rate associated with subsequent strokes is higher than that associated with first strokes. This demonstrates the importance of the study of current parameters for subsequent strokes.

  11. An innovative strategy to increase a professional workforce: the fast track initiative for health visitors in England.

    Science.gov (United States)

    Sayer, Lynn; Barriball, K Louise; Bliss, Julie; Bakhshi, Savita; While, Alison E

    2016-04-01

    Fast tracking is one strategy that organizations use to ameliorate workforce shortfalls by attracting new recruits, and accelerating their skills development and experience. In response to the Government's target of rapidly expanding the number of health visitors in England's National Health Service, the fast track initiative was launched to recruit newly qualified (fast track) as well as experienced (standard entry) nurses and midwives onto health visiting programmes. This paper evaluates the fast track initiative, from the perspective of fast track and standard entry students, practice teachers and health visitor managers. A mixed methods design was used comprising a questionnaire survey (n = 71 students), semi-structured interviews (n = 37 students), telephone interviews (n = 13 managers) and six focus groups (n = 24 practice teachers). Data were collected between April 2012 and July 2013. Descriptive statistics, t-tests and the Pearson Chi-square test were used to analyse the quantitative data. The qualitative data were analysed thematically. Motivations for health visiting as a career choice were similar for fast track and standard entry students, with career progression and interest in health promotion being key motivators. There was consensus that personal qualities and characteristics were more important than experience or qualifications. However, fast track students were significantly less confident about their public health competencies in leadership and management (p communication (p  0.5). Fast tracking offers a useful recruitment strategy in order to expand the health visitor workforce, but longitudinal research is needed to confirm benefits such as retention and career trajectories. © The Author(s) 2015.

  12. Earplugs during the first night after cardiothoracic surgery may improve a fast-track protocol.

    Science.gov (United States)

    Menger, Johannes; Urbanek, Bernhard; Skhirtladze-Dworschak, Keso; Wolf, Viktoria; Fischer, Arabella; Rinösl, Harald; Dworschak, Martin

    2018-01-01

    Sleep deprivation after major surgery is common and associated with worse outcome. Noise is one important reason for sleep fragmentation, which contributes to enhanced morbidity. The purpose of this work was to evaluate the impact of earplugs on patients' sleep quality during their first night after cardiothoracic surgery to eventually improve an existing fast-track concept. Sixty-three patients undergoing cardiothoracic surgery eligible for a postoperative fast-track regimen on our cardiothoracic post anesthesia care unit (C-PACU) were prospectively included. They were randomized to either sleep with or without earplugs. Quality of sleep was measured using questionnaires for patients and nurses. Required pain medications, pain intensity, and length of hospital stay were secondary outcome variables. Twenty-seven patients were randomized to the intervention group (earplugs) and 36 to the control group. Mean (SD) age was 61 (12) years. Self-reported quality of sleep was better in the intervention group (median, IQR [range]: 3, 2-4 [1-5] vs. 4, 3-5 [1-5]; scale: 1, "excellent," to 5, "very poor"; P=0.025). Patients of the intervention group also experienced less severe pain (P=0.047) despite similar dosages of administered analgesics and expressed improved satisfaction regarding their C-PACU stay (P=0.032). Implementation of the use of earplugs in a fast-track concept following cardiothoracic surgery is efficient and easy. Earplugs improved the quality of sleep as well as patient satisfaction and attenuated pain intensity. They may thereby contribute to a faster recovery, less morbidity, and reduced costs.

  13. [Good practice in occupational health services--Certification of stroke as an accident at work. Need for secondary prevention in people returning to work after acute cerebrovascular events].

    Science.gov (United States)

    Marcinkiewicz, Andrzej; Walusiak-Skorupa, Jolanta

    2015-01-01

    The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances). During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI) scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer's post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  14. Good practice in occupational health services – Certification of stroke as an accident at work. Need for secondary prevention in people returning to work after acute cerebrovascular events

    Directory of Open Access Journals (Sweden)

    Andrzej Marcinkiewicz

    2015-08-01

    Full Text Available The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances. During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer’s post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. Med Pr 2015;66(4:595–599

  15. Fast Track to the Cloud: Design Patterns for 12-Factor Earth Sciences Applications

    Science.gov (United States)

    Pawloski, Andrew; McLaughlin, Brett; Lynnes, Christopher

    2016-01-01

    As expanding service offerings and decreasing prices make the cloud increasingly attractive to Earth Science applications, there are nontrivial practical considerations which can hinder its meaningful use. In this talk, we will discuss architectural recommendations and lessons learned while working on EOSDIS' cloud efforts, particularly the NASA-compliant General Application Platform (NGAP) and its associated applications. Prominent in our findings is the importance of 12-factor design patterns and the powerful "wins" they enable in the cloud. We will share our strategies for "fast-tracking" applications to the cloud --whether they be legacy, planned for the future, or somewhere in between.

  16. Postoperative Sleep Disturbances after Zolpidem Treatment in Fast-Track Hip and Knee Replacement

    DEFF Research Database (Denmark)

    Krenk, Lene; Jennum, Poul; Kehlet, Henrik

    2014-01-01

    treatment with zolpidem would significantly improve sleep architecture following...... major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals. CITATION: Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.......STUDY OBJECTIVES: Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep...

  17. Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer Calov; Kehlet, H

    2017-01-01

    : Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ...... was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. CONCLUSION: Ninety-days mortality was 0.3% in THA and TKA, but only 28...

  18. Pathogenesis of morbidity after fast-track laparoscopic colonic cancer surgery

    DEFF Research Database (Denmark)

    Stottmeier, S; Harling, H; Wille-Jørgensen, P

    2011-01-01

    AIM: Analysis of the nature and time course of early complications after laparoscopic colonic surgery is required to allow rational strategies for their prevention and management. METHOD: One hundred and four consecutive patients who underwent elective fast-track laparoscopic colonic cancer surgery...... were analysed prospectively from the Danish Colorectal Cancer Database, supplemented by data from the medical records. We studied in detail the time course of morbidity and reasons for prolonged stay (> 3 days). RESULTS: Seventeen (16.3%) patients had one or more complications. Surgical complications...

  19. Design of a 300-Watt Isolated Power Supply for Ultra-Fast Tracking Converters

    DEFF Research Database (Denmark)

    Nguyen-Duy, Khiem; Ouyang, Ziwei; Petersen, Lars Press

    2015-01-01

    This paper presents the design of a medium-powerrating isolated power supply for ultra-fast tracking converters and MOS-gate driver circuits in medium and high voltage applications. The key feature of the design is its very low circuit input-to-output parasitic capacitance, which maximizes its...... noise immunity from noise due to fast changes in voltage. The converter is a voltage-controlled current source, utilizing a transformer with extremely low inter-winding parasitic capacitance, which is achieved by separating the windings by a significant distance. Experimental measurements show...

  20. Evaluation of a fast-track programme for patients undergoing liver resection

    DEFF Research Database (Denmark)

    Schultz, Nicolai A.; Larsen, Peter Nørgaard; Klarskov, Birthe Michaelsen

    2013-01-01

    removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated......BACKGROUND: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and to decrease morbidity and hospital stay for several major surgical procedures. The aim of this study was to investigate the effect...

  1. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  2. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Directory of Open Access Journals (Sweden)

    Swart Annemiek

    2006-11-01

    Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

  3. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C; Gromov, Kirill

    2016-01-01

    Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such pat......Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality...... in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting....... Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30...

  4. A Fast Track approach to deal with the temporal dimension of crop water footprint

    Science.gov (United States)

    Tuninetti, Marta; Tamea, Stefania; Laio, Francesco; Ridolfi, Luca

    2017-07-01

    Population growth, socio-economic development and climate changes are placing increasing pressure on water resources. Crop water footprint is a key indicator in the quantification of such pressure. It is determined by crop evapotranspiration and crop yield, which can be highly variable in space and time. While the spatial variability of crop water footprint has been the objective of several investigations, the temporal variability remains poorly studied. In particular, some studies approached this issue by associating the time variability of crop water footprint only to yield changes, while considering evapotranspiration patterns as marginal. Validation of this Fast Track approach has yet to be provided. In this Letter we demonstrate its feasibility through a comprehensive validation, an assessment of its uncertainty, and an example of application. Our results show that the water footprint changes are mainly driven by yield trends, while evapotranspiration plays a minor role. The error due to considering constant evapotranspiration is three times smaller than the uncertainty of the model used to compute the crop water footprint. These results confirm the suitability of the Fast Track approach and enable a simple, yet appropriate, evaluation of time-varying crop water footprint.

  5. Fast-track program in laparoscopic liver surgery: Theory or fact?

    Science.gov (United States)

    Sánchez-Pérez, Belinda; Aranda-Narváez, José Manuel; Suárez-Muñoz, Miguel Angel; Eladel-Delfresno, Moises; Fernández-Aguilar, José Luis; Pérez-Daga, Jose Antonio; Pulido-Roa, Ysabel; Santoyo-Santoyo, Julio

    2012-11-27

    To analyze our results after the introduction of a fast-track (FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit. All patients (43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups: Control group (CG) from March 2004 until December 2006 with traditional perioperative cares (17 patients) and fast-track group (FTG) from January 2007 until March 2010 with FT program cares (26 patients). Primary endpoint was the influence of the program on the postoperative stay, the amount of re-admissions, morbidity and mortality. Secondarily we considered duration of surgery, use of drains, conversion to open surgery, intensive cares needs and transfusion. Both groups were homogeneous in age and sex. No differences in technique, time of surgery or conversion to open surgery were found, but more malignant diseases were operated in the FTG, and then transfusions were higher in FTG. Readmissions and morbidity were similar in both groups, without mortality. Postoperative stay was similar, with a median of 3 for CG vs 2.5 for FTG. However, the 80.8% of patients from FTG left the hospital within the first 3 d after surgery (58.8% for CG). The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions, which leads to a reduction of the stay and costs.

  6. The use of a break-even analysis: financial analysis of a fast-track program.

    Science.gov (United States)

    Saywell, R M; Cordell, W H; Nyhuis, A W; Giles, B K; Culler, S D; Woods, J R; Chu, D K; McKinzie, J P; Rodman, G H

    1995-08-01

    To calculate the financial break-even point and illustrate how changes in third-party reimbursement and eligibility could affect a program's fiscal standing. Demographic, clinical, and financial data were collected retrospectively for 446 patients treated in a fast-track program during June 1993. The fast-track program is located within the confines of the emergency medicine and trauma center at a 1,050-bed tertiary care Midwestern teaching hospital and provides urgent treatment to minimally ill patients. A financial break-even analysis was performed to determine the point where the program generated enough revenue to cover its total variable and fixed costs, both direct and indirect. Given the relatively low average collection rate (62%) and high percentage of uninsured patients (31%), the analysis showed that the program's revenues covered its direct costs but not all of the indirect costs. Examining collection rates or payer class mix without examining both costs and revenues may lead to an erroneous conclusion about a program's fiscal viability. Sensitivity analysis also shows that relatively small changes in third-party coverage or eligibility (income) requirements can have a large impact on the program's financial solvency and break-even volumes.

  7. Application of fast track surgery in routine nursing for patient with colorectal cancer.

    Science.gov (United States)

    Liu, Yongrui

    2017-12-01

    Objective : To investigate the clinical effect of fast track surgery (FTS) in perioperative nursing of colorectal cancer surgery. Background : In recent years, many complicated surgery began to develop in the direction of low invasion and short hospital time, which provides an unprecedented opportunity for the development of fast track surgery (FTS). Methods : According to different nursing measures, 156 cases of colorectal cancer patients treated in our hospital were divided into FTS nursing group (86 cases) and traditional nursing group (70 cases). FTS nursing care and traditional nursing care were respectively employed to analyze and compare postoperative recovery and complications of the two groups. Results : FTS nursing group was significantly shorter than the traditional care group in terms of the first postoperative exhaust time, the first defecation time, the first eating time, ambulation time and postoperative hospital time, with statistical significance ( P  < .05); compared with the conventional nursing group, FTS group significantly had lower incidence of postoperative intestinal obstruction, lower limb vein thrombus formation and gastrointestinal discomfort, with statistical significance ( P  < .05); FTS group has less situations of nausea and vomiting, incision infection, pulmonary infection, urinary tract infection and anastomotic leakage compared to the conventional nursing group. Conclusion : FTS nursing can effectively promote the postoperative recovery of intestinal function for patients with colorectal cancer and reduce the occurrence of postoperative complications, which will relieve postoperative pain and shorten the length of stay, giving patients increased rehabilitation quality.

  8. Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders

    2017-01-01

    transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds...... ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics. RESULTS Of 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the “no-SSRI” group received blood intra- or postoperatively.......79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not. CONCLUSIONS Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA....

  9. Liberal or restrictive fluid administration in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Holte, K; Foss, N B; Andersen, J

    2007-01-01

    BACKGROUND: Evidence-based guidelines on optimal perioperative fluid management have not been established, and recent randomized trials in major abdominal surgery suggest that large amounts of fluid may increase morbidity and hospital stay. However, no information is available on detailed...... surgery were randomized to 'restrictive' (Group 1) or 'liberal' (Group 2) perioperative fluid administration. Fluid algorithms were based on fixed rates of crystalloid infusions and a standardized volume of colloid. Pulmonary function (spirometry) was the primary outcome measure, with secondary outcomes...... of exercise capacity (submaximal exercise test), orthostatic tolerance, cardiovascular hormonal responses, postoperative ileus (transit of radio-opaque markers), postoperative nocturnal hypoxaemia, and overall recovery within a well-defined multimodal, fast-track recovery programme. Hospital stay...

  10. "Fast-track" strategies in long-term public disability programs around the world.

    Science.gov (United States)

    Rajnes, David

    2012-01-01

    Long-term public disability programs in the United States and several other countries have incorporated fast-track (FT) procedures that share a common goal of accelerating applicants through various stages of the disability determination process--generally for those with severe disabilities, blindness, or terminal illness. This article identifies a variety of FT procedures either implemented or under consideration in public long-term disability programs operated in the United States and other countries; compares FT procedures in those disability programs with respect to specific program features, differences with respect to the administrative components involved in those procedures, and the level of technology used; examines more generally why countries may consider implementing FT procedures; and describes how FT procedures may be employed to improve overall processing of claims and contribute to disability case management.

  11. First prototype of a silicon tracker using an artificial retina for fast track finding

    CERN Document Server

    Neri, N.; Caponio, F.; Citterio, M.; Coelli, S.; Fu, J.; Geraci, A.; Monti, M.; Petruzzo, M.; Bedeschi, F.; Marino, P.; Morello, M.J.; Piucci, A.; Punzi, G.; Spinella, F.; Stracka, S.; Walsh, J.; Ristori, L.; Tonelli, D.

    2014-01-01

    We report on the R\\&D for a first prototype of a silicon tracker based on an alternative approach for fast track finding. The working principle is inspired from neurobiology, in particular by the processing of visual images by the brain as it happens in nature. It is based on extensive parallelisation of data distribution and pattern recognition. In this work we present the design of a practical device that consists of a telescope based on single-sided silicon detectors; we describe the data acquisition system and the implementation of the track finding algorithms using available digital logic of commercial FPGA devices. Tracking performance and trigger capabilities of the device are discussed along with perspectives for future applications.

  12. Health preemption behind closed doors: trade agreements and fast-track authority.

    Science.gov (United States)

    Crosbie, Eric; Gonzalez, Mariaelena; Glantz, Stanton A

    2014-09-01

    Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies' influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. "Fast-track authority," in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests.

  13. FATRAS - A Novel Fast Track Simulation Engine for the ATLAS Experiment

    CERN Document Server

    Fleischmann, S; The ATLAS collaboration

    2010-01-01

    Monte Carlo simulation of the detector response is an inevitable part of any kind of analysis which is performed with data from the LHC experiments. These simulated data sets are needed with large statistics and high precision level, which makes their production a CPU-cost intensive task. ATLAS has thus concentrated on optimizing both full and fast detector simulation techniques to achieve this goal within the computing limits of the collaboration. At the early stages of data-taking, in particular, it is necessary to reprocess the Monte Carlo event samples continuously, while integrating adaptations to the simulation modules to improve the agreement with the data taken from the detector itself. We present a new, fast track simulation engine which establishes a full Monte Carlo simulation which is based on modules and the geometry of the ATLAS standard track reconstruction application. This is combined with a fast parametric-response simulation of the Calorimeter. This approach shows a high level of agreement ...

  14. The value of materials R&D in the fast track development of fusion power

    Science.gov (United States)

    Ward, D. J.; Taylor, N. P.; Cook, I.

    2007-08-01

    The objective of the international fusion program is the creation of power plants with attractive safety and environmental features and viable economics. There is a range of possible plants that can meet these objectives, as studied for instance in the recent EU studies of power plant concepts. All of the concepts satisfy safety and environmental objectives but the economic performance is interpreted differently in different world regions according to the perception of future energy markets. This leads to different materials performance targets and the direction and timescales of the materials development programme needed to meet those targets. In this paper, the implications for materials requirements of a fast track approach to fusion development are investigated. This includes a quantification of the overall benefits of more advanced materials: including the effect of trading off an extended development time against a reduced cost of electricity for resulting power plants.

  15. Impact of the fast track prevention program on health services use by conduct-problem youth.

    Science.gov (United States)

    Jones, Damon; Godwin, Jennifer; Dodge, Kenneth A; Bierman, Karen L; Coie, John D; Greenberg, Mark T; Lochman, John E; McMahon, Robert J; Pinderhughes, Ellen E

    2010-01-01

    We tested the impact of the Fast Track conduct disorder prevention program on the use of pediatric, general health, and mental health services in adolescence. Participants were 891 public kindergarten boys and girls screened from a population of 9594 children and found to be at risk for conduct disorder. They were assigned randomly (by school) to intervention or control conditions and were followed for 12 years. Intervention lasted 10 years and included parent training, child social-cognitive skills training, reading tutoring, peer-relations enhancement, and classroom curricula and management. Service use was assessed through annual interviews of parents and youth. Youth assigned to preventive intervention had significantly reduced use of professional general health, pediatric, and emergency department services relative to control youth on the basis of parent-report data. For control-group youth, the odds of greater use of general health services for any reason and general health services use for mental health purposes were roughly 30% higher and 56% higher, respectively. On the basis of self-report data, the intervention reduced the likelihood of outpatient mental health services among older adolescents for whom odds of services use were more than 90% higher among control-group youth. No differences were found between intervention and control youth on the use of inpatient mental health services. Statistical models controlled for key study characteristics, and potential moderation of the intervention effect was assessed. Random assignment to the Fast Track prevention program is associated with reduced use of general health and outpatient mental health services in adolescents. Future studies should examine the mechanism of this impact and service use patterns as subjects reach young adulthood.

  16. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length o...

  17. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps

    DEFF Research Database (Denmark)

    Bonde, Christian; Khorasani, Hoda; Eriksen, Kirsten

    2015-01-01

    INTRODUCTION: The concept of fast-track surgery (FTS) is a peri- and postoperative care concept developed to reduce length of hospital stay (LOS) and morbidity after surgery. FTS programmes have been reported from other surgical specialities, but there are few reports of FTS in plastic surgery. M...

  18. Fast-track, ambulatory ultrasound-guided Tru-Cut liver biopsy is feasible and cost-efficient

    DEFF Research Database (Denmark)

    Huang, Chenxi; Lorentzen, Torben; Skjoldbye, Bjørn

    2015-01-01

    safely discharged from our institution. No fatality or long-term complications were found during this study. CONCLUSION: The fast-track approach reported herein is a feasible option when adequate patient information is given. Besides the obvious, positive effect on patient logistics and departmental...

  19. Fast-track, ambulatory ultrasound-guided Tru-Cut liver biopsy is feasible and cost-efficient

    DEFF Research Database (Denmark)

    Huang, Chenxi; Lorentzen, Torben; Skjoldbye, Bjørn

    2015-01-01

    INTRODUCTION: Most institutions perform percutaneous liver biopsy with a post-biopsy patient observation period lasting up to eight hours, which is resource-demanding. This study aimed to evaluate the safety of liver biopsy performed in a fast-track set-up with an only one-hour post-biopsy observ......INTRODUCTION: Most institutions perform percutaneous liver biopsy with a post-biopsy patient observation period lasting up to eight hours, which is resource-demanding. This study aimed to evaluate the safety of liver biopsy performed in a fast-track set-up with an only one-hour post......-biopsy observation time. METHODS: Patients referred to our institution underwent fast-track ultrasound-guided 18-gauge Tru-Cut liver biopsy procedures. Each single biopsy procedure was followed by a post-procedure observational period of one hour and an additional focused assessment with sonography for trauma before...... safely discharged from our institution. No fatality or long-term complications were found during this study. CONCLUSION: The fast-track approach reported herein is a feasible option when adequate patient information is given. Besides the obvious, positive effect on patient logistics and departmental...

  20. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair.

    Science.gov (United States)

    Muehling, Bernd; Schelzig, Hubert; Steffen, Peter; Meierhenrich, Rainer; Sunder-Plassmann, Ludger; Orend, Karl-Heinz

    2009-03-01

    Fast-track recovery programs have led to reduced patient morbidity and mortality after major surgery. In terms of elective open infrarenal aneurysm repair, no evidence is available about such programs. To address this issue, we have conducted a randomized prospective pilot study. The study involved prospective randomization of 101 patients with the indication for elective open aneurysm repair in a traditional and a fast-track treatment arm. The basic fast-track elements were no bowel preparation, reduced preoperative fasting, patient-controlled epidural analgesia (PCEA), enhanced postoperative feeding, and postoperative mobilization. Morbidity and mortality, need for postoperative mechanical ventilation, length of stay (LOS) in the intensive care unit (ICU) and total length of postoperative hospital stay were analyzed in terms of an intention to treat. Demographic data for the two groups were similar. In the fast-track group the need for postoperative ventilation was significantly lower (6.1% versus 32%; p = 0.002), the median LOS on ICU did not significantly differ (20 h versus 32 h; p = 0.183), full enteral feeding was achieved significantly earlier (5 versus 7 days; p < 0.0001), and the rate of postoperative medical complications-gastrointestinal, cardiac, pulmonary, renal, and infective-was significantly lower (16% versus 36%; p = 0.039). The postoperative hospital stay was significantly shorter in the fast-track group (10 days versus 11 days; p = 0.016); the mortality rate in both groups was 0%. An optimized patient care program in open infrarenal aortic aneurysm repair shows favorable results concerning need for postoperative assisted mechanical ventilation, time to full enteral feeding, and incidence of medical complications. Further ranomized multicentric trials are necessary to justify broad implementation (clinical trials. gov identifier NCT 00615888).

  1. Experience with "Fast track" postoperative care after deep brain stimulation surgery.

    Science.gov (United States)

    Martín, Nuria; Valero, Ricard; Hurtado, Paola; Gracia, Isabel; Fernández, Carla; Rumià, Jordi; Valldeoriola, Francesc; Carrero, Enrique J; Tercero, Francisco Javier; de Riva, Nicolás; Fàbregas, Neus

    A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). We evaluated the impact of a fast-track (FT) postoperative care protocol. An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6h. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Fertility and the fast-track: Continued childbearing among professionals in Sweden, 1991-2009

    Directory of Open Access Journals (Sweden)

    Maria Stanfors

    2014-08-01

    Full Text Available Background: During recent decades women have made considerable advances in education and the labor market, even in fast-track professions such as law, medicine, and academia. While women have entered high-status professions, the career paths of some jobs have changed little and are still inflexible, which implies that professional gains may be offset by familial losses. Objective: We investigate continued childbearing, focusing on the relationship between occupation and second and third births, among highly educated men and women in three high-status professions. Methods: We analyze the determinants of having a second or a third birth using longitudinal data from population registers in Sweden, 1991-2009. We use descriptive statistics and logistic models. Results: Net of demographic and socioeconomic controls, medical doctors are more likely to continue childbearing than lawyers and academics, irrespective of parity and gender. The patterns that emerge are independent of income. Public sector work is conducive to continued childbearing, especially for women. Conclusions: Although there are more opportunities to combine career and family in Sweden than in many other countries, this does not hold equally for all. The results indicate that working conditions and career structures contribute to making it easier for some groups than others to combine a professional career and children. Patterns that emerge reflect that women and men are not equally sensitive to career structures that imply a tradeoff between career and children at an early stage of the career. This puts policies promoting work and family for all into perspective.

  3. Dental fast track: prenatal enamel growth, incisor eruption, and weaning in human infants.

    Science.gov (United States)

    Mahoney, Patrick

    2015-03-01

    Correlation between the timing of permanent first molar eruption and weaning age in extant primates has provided a way to infer a life history event in fossil species, but recent debate has questioned whether the same link is present in human infants. Deciduous incisors erupt at an age when breast milk can be supplemented with additional foods (mixed feeding), and weaning is typically complete before permanent first molars erupt. Here, I use histological methods to calculate the prenatal rate by which enamel increases in thickness and height on human deciduous incisors, canines, and molars (n = 125). Growth trajectories for each tooth type are related to the trimesters and assessed against the eruption sequence and final crown height. Analyses show that central incisors initiate early in the second trimester with significantly faster secretion rates relative to canines and second molars, which initiate closer to birth. Even though initial extension rates were correlated with crown height and scaled with positive allometry within each tooth class, the relatively short incisors still increased in height at a significantly faster rate than the taller canines and molars. The incisor prenatal "fast track" produces a greater proportion of the crown before birth than all other tooth types. This growth mechanism likely facilitates early incisor eruption at a time when the mixed feeding of infants can be initiated as part of the weaning process. Findings provide a basis from which to explore new links between developmental trends along the tooth row and mixed feeding age in other primates. © 2014 Wiley Periodicals, Inc.

  4. Orchestrating care through the fast-track perspective: Orthopaedic nurses’ perceptions and experiences of providing individualised nursing care in older patients’ standardised fast-track programmes after total hip or knee replacement

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Frederiksen, Kirsten

    2017-01-01

    individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion......The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised...... fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim...

  5. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik

    2014-01-01

    BACKGROUND: Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast...... DESIGN AND METHODS: This was a prospective observational database study with data obtained from six high-volume Danish fast-track surgical centers. Preoperative hemoglobin and patient demographics were collected prospectively using questionnaires while outcome and transfusion data were collected using......-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. STUDY...

  6. A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars

    2014-01-01

    In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... procedures. The purpose of this study is to present a model for fast track handling of patients suspicious of cancer in the head and neck region and to evaluate the effect of implementation on the diagnostic work up time. Patients with suspicion of HNC referred to the same university department of ENT Head...... and Neck Surgery during three comparable time intervals 2006-2007, 2007-2008, and 2011-2012 (groups 1-3) were investigated. We recorded the time from patient referral, to first consultation and final diagnosis. The first interval was before initiation of the "package solution", the second just after...

  7. Fast-track, ambulatory ultrasound-guided Tru-Cut liver biopsy is feasible and cost-efficient

    DEFF Research Database (Denmark)

    Huang, Chenxi; Lorentzen, Torben; Skjoldbye, Bjørn

    2015-01-01

    INTRODUCTION: Most institutions perform percutaneous liver biopsy with a post-biopsy patient observation period lasting up to eight hours, which is resource-demanding. This study aimed to evaluate the safety of liver biopsy performed in a fast-track set-up with an only one-hour post......-biopsy observation time. METHODS: Patients referred to our institution underwent fast-track ultrasound-guided 18-gauge Tru-Cut liver biopsy procedures. Each single biopsy procedure was followed by a post-procedure observational period of one hour and an additional focused assessment with sonography for trauma before...... throughput, this approach may also reduce diagnostic work-up time and bring financial benefits. Therefore, we encourage the use of this approach in institutions comparable to our own. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  8. Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty.

    Science.gov (United States)

    Gylvin, Silas Hinsch; Jørgensen, Christoffer Calov; Fink-Jensen, Anders; Johansson, Pär I; Kehlet, Henrik

    2017-04-01

    Selective serotonin reuptake inhibitors (SSRIs) and other psychotropics are receiving increasing attention due to reports on inhibition of thrombocyte function and an increased bleeding risk in surgical settings. Studies in total hip and total knee arthroplasty (THA and TKA, respectively) have shown conflicting results, questioning whether the potential increased bleeding risk is of clinical importance. Prospective consecutive collection of data on preoperative comorbidity in patients undergoing primary unilateral THA or TKA was cross-referenced with regional transfusion databases and The Danish National Database of Reimbursed Prescriptions for information regarding blood transfusions and psychopharmacologic treatment. All participating orthopedic centers followed similar perioperative guidelines. Multiple logistic regression analysis was applied to calculate odds ratios (ORs) for transfusion between preoperative users and nonusers of psychotropics. Of 8402 patients, 569 (6.8%) were SSRI users versus 7833 (93.2%) nonusers. A total of 109 (19,2%) patients in the SSRI group and 700 (8.9%) in the "no-SSRI" group received blood intra- or postoperatively. Preoperative SSRI treatment was a risk factor for perioperative transfusion (OR, 1.98; 95% confidence interval [CI], 1.44-2.70). Other antidepressants (OAs) were associated with an increased risk of transfusion (OR, 1.69; 95% CI, 1.17-2.44) as well as the combination of SSRIs and OAs (OR, 3.31; 95% CI, 1.79-6.13). Singular use of antipsychotics (APs) increased the transfusion risk (OR, 2.37; 95% CI, 1.04-2.41), while AP medicine in combination with antidepressants did not. Preoperative treatment with SSRIs, OAs, or APs are independent risk factors for blood transfusion in elective fast-track THA and TKA. © 2017 AABB.

  9. [Application of clinical nursing pathway in fast-track program of splenomegaly advanced schistosomiasis patients].

    Science.gov (United States)

    Zhou, Rui-hong; Liu, Jia-xin; Pan, Jie; Zhou, Lu; Liu, Ling; Li, Qin

    2015-10-01

    To evaluate the effect of clinical nursing pathway in fast-track program (FTS-CNP) in splenomegaly advanced schistosomiasis patients during the perioperative period. A total of 80 patients with splenomegaly advanced schistosomiasis who were treated with selective operation in the Affiliated Xiangyue Hospital of Hunan Institute of Parasitic Diseases from January, 2012 to December, 2014 were divided into an observation group (n = 40) and a control group (n = 40). FTS-CNP was implemented in the observation group, while the routine nursing was used in the control group. Then the physical rehabilitation and psychological health levels of the patients in the two groups post-operation were observed and compared. After the operation, the duration of first taking food [(14.67 ± 2.90) h], first anus exhausting [(25.30 ± 3.46) h], first off-bed activity [ (29.40 ± 5.57) h], as well as the duration of hospital stays [(19.00 ± 2.82) d] of patients in the observation group were all shorter than those of the patients in the control group [(44.50 ± 6.71) h, (52.80 ± 6.95) h, (35.05 ± 10.37) h, (25.08 ± 2.39) d, respectively] , and the incidence rate of postoperative complications (7.50%) of the former was lower than that of the latter (25.00%), and all the differences were statistically significant (all P observation group were lower than those of the patients in the control group (46.89 8.92, 47.06 ± 10.29), both differences were statistically significant (both P < 0.01). FTS-CNP can promote the physical and psychological recovery of the splenomegaly advanced schistosomiasis patients post-operation, and also can shorten the hospitals stays and reduce the complications.

  10. Fast track-finding processor based on RAM look-up table for the VENUS detector at KEK

    Energy Technology Data Exchange (ETDEWEB)

    Ohsugi, T.; Chiba, Y.; Hayashibara, I.; Taketani, A.; Yasuishi, S.; Arai, Y.; Sakamoto, H.; Uehara, S.

    1988-06-20

    We have developed a fast track-finding processor using signals from the central tracking chamber of the VENUS detector in the TRISTAN experiments. Particle tracks are recognized by a look-up table made with a high-speed static RAM. This method enables us to implement the track finder in the first level triggering. The track finder has been working excellently under heavy background due to synchroton radiation. A processing time of 110 ns is attained.

  11. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.

    Science.gov (United States)

    Wilches, C; Sulbarán, J D; Fernández, J E; Gisbert, J M; Bausili, J M; Pelfort, X

    To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Fast-track pathway for reduction of dislocated hip arthroplasty reduces surgical delay and length of stay

    DEFF Research Database (Denmark)

    Gromov, Kirill; Willendrup, Fatin; Palm, Henrik

    2015-01-01

    -track patients with a suspected dislocation (with no radiographic verification) were moved directly to the post-anesthesia care unit and then straight to the operating room. Dislocation was confirmed under fluoroscopy with reduction under general anesthesia. Surgical delay (in hours), LOS (in hours......), perioperative complications, and complications during the hospital stay were recorded. Dislocation status for fast-track patients (confirmed or unconfirmed by fluoroscopy) was also recorded. RESULTS: Both surgical delay (2.5 h vs. 4.1 h; p

  13. Getting on the fast track, or how to get an MLIS through distance education, with a specialization in medical librarianship.

    Science.gov (United States)

    Detlefsen, Ellen G

    2004-01-01

    The article describes an innovation in MLIS education for medical librarianship, with an introduction to the FastTrack, the distance education program at the University of Pittsburgh's library and information science school, together with an overview of a model program linking the biomedical library at Vanderbilt University with the School of Information Sciences in Pittsburgh. Admissions requirements and specific curriculum for the distance education master's degree are detailed in an FAQ format.

  14. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty.

    Science.gov (United States)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik; Johansson, Pär I

    2014-03-01

    Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. This was a prospective observational database study with data obtained from six high-volume Danish fast-track surgical centers. Preoperative hemoglobin and patient demographics were collected prospectively using questionnaires while outcome and transfusion data were collected using national databases and patient charts. Adjusted risk estimates for transfusion, prolonged LOS, and all-cause readmission according to preoperative anemia status were obtained by multivariate logistic regression. A total of 5.165 THA or TKA procedures were included with a mean patient age of 67 ± 11 years and a median LOS of 2 (interquartile range, 2-3) days. A total of 662 patients (12.8%) had preoperative anemia according to World Health Organization classification. Preoperative anemia was associated with increased risk of receiving transfusion during admission (odds ratio [OR], 4.7; 95% confidence interval [CI], 3.8-5.8), increased risk of readmission within 90 days from surgery (OR, 1.4; 95% CI, 1.1-1.9), and increased risk of LOS of more than 5 days (OR, 2.5; 95% CI, 1.9-3.4) after adjustment for preoperative patient-related risk factors. Preoperative anemia in elective fast-track THA and TKA is independently associated with transfusion and increased postoperative morbidity, supporting the need for preoperative evaluation and treatment. © 2013 American Association of Blood Banks.

  15. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Husted, Henrik

    2011-01-01

    OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective, descrip......OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective......, descriptive, hypothesis-generating study. SETTING: A special unit for fast-track hip and knee arthroplasty operations at a university hospital. PARTICIPANTS: Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. METHODS: All patients were evaluated before surgery...... and on the day of hospital discharge. MAIN OUTCOME MEASURES: Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). RESULTS: All investigated variables changed significantly from before to after surgery...

  16. Safeguarding Self-Governance: A Grounded Theory of Older Patients’ Pattern of Behavior in Relation to their Relatives in Fast-track Programs

    DEFF Research Database (Denmark)

    Berthelsen, Connie B.; Frederiksen, Kirsten; Lindhardt Damsgaard, Tove

    2014-01-01

    Abstract The aim of this study was to generate a grounded theory of older patients’ pattern of behavior in relation to their relatives’ involvement in fast-track programs during total joint replacement. Sixteen patients were recruited in orthopedic wards. Data collection included 11 interviews...... with patients and 15 non-participant observations of interactions between patients, relatives, and health professionals during scheduled meetings throughout the fast-track program. The constant comparative method was used for simultaneous data collection, data analysis, and coding. Safeguarding self......, shielding, distancing, and masking. Keywords: Fast-track program, grounded theory, older patients, relatives, total joint replacement....

  17. Safeguarding Self-Governance: A Grounded Theory of Older Patients’ Pattern of Behavior in Relation to their Relatives in Fast-track Programs

    DEFF Research Database (Denmark)

    Berthelsen, Connie B.; Frederiksen, Kirsten; Lindhardt Damsgaard, Tove

    2014-01-01

    Abstract The aim of this study was to generate a grounded theory of older patients’ pattern of behavior in relation to their relatives’ involvement in fast-track programs during total joint replacement. Sixteen patients were recruited in orthopedic wards. Data collection included 11 interviews......-governance emerged in the analysis as the core category of our theory and pattern of behavior of the older patients in relation to their relatives. The older patients’ main concern was to complete the fast-track program while maintaining autonomy, which they resolved through four strategies of actions: embracing......, shielding, distancing, and masking. Keywords: Fast-track program, grounded theory, older patients, relatives, total joint replacement....

  18. Integrative taxonomy on the fast track - towards more sustainability in biodiversity research.

    Science.gov (United States)

    Riedel, Alexander; Sagata, Katayo; Suhardjono, Yayuk R; Tänzler, Rene; Balke, Michael

    2013-03-27

    A so called "taxonomic impediment" has been recognized as a major obstacle to biodiversity research for the past two decades. Numerous remedies were then proposed. However, neither significant progress in terms of formal species descriptions, nor a minimum standard for descriptions have been achieved so far. Here, we analyze the problems of traditional taxonomy which often produces keys and descriptions of limited practical value. We suggest that phylogenetics and phenetics had a subtle and so far unnoticed effect on taxonomy leading to inflated species descriptions. The term "turbo-taxonomy" was recently coined for an approach combining cox1 sequences, concise morphological descriptions by an expert taxonomist, and high-resolution digital imaging to streamline the formal description of larger numbers of new species. We propose a further development of this approach which, together with open access web-publication and automated pushing of content from journal into a wiki, may create the most efficient and sustainable way to conduct taxonomy in the future. On demand, highly concise descriptions can be gradually updated or modified in the fully versioned wiki-framework we use. This means that the visibility of additional data is not compromised, while the original species description -the first version- remains preserved in the wiki, and of course in the journal version. A DNA sequence database with an identification engine replaces an identification key, helps to avoid synonyms and has the potential to detect grossly incorrect generic placements. We demonstrate the functionality of a species-description pipeline by naming 101 new species of hyperdiverse New Guinea Trigonopterus weevils in the open-access journal ZooKeys. Fast track taxonomy will not only increase speed, but also sustainability of global species inventories. It will be of great practical value to all the other disciplines that depend on a usable taxonomy and will change our perception of global

  19. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kehlet, Henrik; Hansen, Torben Bæk

    2013-01-01

    Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after...... these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA....

  20. A fast track trigger processor for the OPAL detector at LEP

    International Nuclear Information System (INIS)

    Carter, A.A.; Jaroslawski, S.; Wagner, A.

    1986-01-01

    A fast hardware track trigger processor being built for the OPAL experiment is described. The processor will analyse data from the central drift chambers of OPAL to determine whether any tracks come from the interaction region, and thereby eliminate background events. The processor will find tracks over a large angular range, vertical strokecos thetavertical stroke < or approx. 0.95. The design of the processor is described, together with a brief account of its hardware implementation for OPAL. The results of feasibility studies are also presented. (orig.)

  1. 'Fast-track' colonic surgery in Austria and Germany--results from the survey on patterns in current perioperative practice.

    Science.gov (United States)

    Hasenberg, T; Keese, M; Längle, F; Reibenwein, B; Schindler, K; Herold, A; Beck, G; Post, S; Jauch, K W; Spies, C; Schwenk, W; Shang, E

    2009-02-01

    'Fast-track' rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts among the entirety of Austrian and German surgeons. In 2006, a questionnaire concerning perioperative routines in elective, open colonic resection was sent to the chief surgeons of 1270 German and 120 Austrian surgical centres. The response rate was 63% in Austria (76 centres) and 30% in Germany (385 centres). Mechanical bowel preparation is used by the majority (Austria, 91%; Germany, 94%); the vertical incision is the standard method of approach to the abdomen in Austria (79%) and Germany (83%), nasogastric decompression tubes are rarely used, one-third of the questioned surgeons in both countries use intra-abdominal drains. Half of the surgical centres allow the intake of clear fluids on the day of surgery and one-fifth offer solid food on that day. Epidural analgesia is used in three-fourths of the institutions. Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine in Austria and Germany.

  2. A renal colic fast track pathway to improve waiting times and outcomes for patients presenting to the emergency department

    Directory of Open Access Journals (Sweden)

    Al Kadhi O

    2017-07-01

    Full Text Available Omar Al Kadhi,1 Kate Manley,1 Madhavi Natarajan,1 Valmiki Lutchmedial,2 Abbi Forsyth,2 Kate Tabrett,2 Jonathan Betteridge,2 William Finch,3 Heinrich Hollis4 1Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, 2Faculty of Medicine and Health Sciences, University of East Anglia, 3Department of Urology, 4Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK Introduction: Renal colic is commonly encountered in the emergency department (ED. We validated a fast track renal colic (FTRC initiative to decrease patient waiting times and streamline patient flow.Method: The FTRC pathway was devised according to the National Institute for Health and Care Excellence clinical summary criteria for the management of patients with suspected renal colic. ED triage nurses use the pathway to identify patients with likely renal colic suitable for fast track to analgesia, investigation and management. Investigations, diagnosis and patient demographics were recorded for 1157 consecutive patients coded as renal colic at a single-center ED over 12 months.Results: Three hundred and two patients were suitable for the FTRC pathway (26.1%, while 855 were seen by the ED clinicians prior to onward referral. Also, 83.9% of patients underwent computed tomography scan. In the FTRC group, 57.3% of patients had radiologically confirmed calculi versus 53.8% in the non-FTRC group (p=0.31. Alternative diagnoses among FTRC patients (2.6% included ovarian pathology (n=1, diverticulitis (n=2 and incidental renal cell carcinoma (n=2, while 26.1% had no identifiable pathology. No immediately life-threatening diagnoses were identified on imaging. Computed tomography scans performed in the non-FTRC group identified two ruptured abdominal aortic aneurysms and alternative diagnoses (2.57% including ovarian pathology (n=7, cholecystitis (n=2, incidental renal cell carcinoma (n=3 and inflammatory bowel

  3. Spouses’ involvement in older patients’ fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Kristensson, Jimmie

    2015-01-01

    Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part...... and subsequently include the intervention group to avoid contamination of the control group. A case manager will be recruited to perform the case management intervention. Data will be collected from both groups at baseline, 2 weeks and 3 months after surgery. Outcome measures for patients include: functional...... to education of the health professionals in their need to include relatives in fast-track programmes. The study was funded by the Novo Nordisk Foundation and the Regional Health Scientific Foundation of Sealand....

  4. Indirect Effects of the Fast Track Intervention on Conduct Disorder Symptoms and Callous-Unemotional Traits: Distinct Pathways Involving Discipline and Warmth.

    Science.gov (United States)

    Pasalich, Dave S; Witkiewitz, Katie; McMahon, Robert J; Pinderhughes, Ellen E

    2016-04-01

    Little is known about intervening processes that explain how prevention programs improve particular youth antisocial outcomes. We examined whether parental harsh discipline and warmth in childhood differentially account for Fast Track intervention effects on conduct disorder (CD) symptoms and callous-unemotional (CU) traits in early adolescence. Participants included 891 high-risk kindergarteners (69% male; 51% African American) from urban and rural United States communities who were randomized into either the Fast Track intervention (n = 445) or non-intervention control (n = 446) groups. The 10-year intervention included parent management training and other services (e.g., social skills training, universal classroom curriculum) targeting various risk factors for the development of conduct problems. Harsh discipline (Grades 1 to 3) and warmth (Grades 1 and 2) were measured using parent responses to vignettes and direct observations of parent-child interaction, respectively. Parents reported on children's CD symptoms in Grade 6 and CU traits in Grade 7. Results demonstrated indirect effects of the Fast Track intervention on reducing risk for youth antisocial outcomes. That is, Fast Track was associated with lower scores on harsh discipline, which in turn predicted decreased levels of CD symptoms. In addition, Fast Track was associated with higher scores on warmth, which in turn predicted reduced levels of CU traits. Our findings inform developmental and intervention models of youth antisocial behavior by providing evidence for the differential role of harsh discipline and warmth in accounting for indirect effects of Fast Track on CD symptoms versus CU traits, respectively.

  5. A reengineering success story: process improvement in emergency department x-ray cycle time, leading to breakthrough performance in the ED ambulatory care (Fast Track) process.

    Science.gov (United States)

    Espinosa, J A; Treiber, P M; Kosnik, L

    1997-01-01

    This article describes the journey of a multidisciplinary reengineering team, which worked to reduce a critical, high-leverage process in an emergency department setting. The process selected was emergency department radiology services. This process was selected on a rational basis. The team knew tht 60 percent of our emergency department patients were truly ambulatory, and that most could be seen in a "fast track" process as part of our emergency department's core mission. However, we knew from customer satisfaction data, that patients would like to be "in and out" of emergency department Fast Track in less than an hour. Over half of our Fast Track patients require x-rays. For most, this was their sole reason for seeking emergency care. Our state, at the start of the project, included an average x-ray cycle time of over 60 minutes. The associated Fast-Track cycle time was over 90 minutes median. It was clear to the emergency department leadership, as well as to members of the Fast-Track management team, that a cycle time of 30 minutes or less for x-ray service was needed as a necessary condition to an hour or less Fast Track cycle time. It was also felt that a more rapid x-ray cycle time would allow for more rapid turn over of ED rooms, leading to a virtual greater capacity to the ED. It was hoped that this would lead to a reduction in the time from arrival to treatment by the emergency physician for all patients.

  6. Postoperative Urinary Catheterization Thresholds of 500 versus 800 ml after Fast-track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Hornum, Ulla; Troldborg, Charlotte

    2016-01-01

    according to group assignment. The primary outcome was the number of patients catheterized before their first voluntary micturition. Thirty-day telephonic follow-up was on voiding difficulties, urinary tract infections, and readmissions. RESULTS: Of 800 patients allocated, 721 (90%) were included in a per......BACKGROUND: No evidence-based threshold exists for postoperative urinary bladder catheterization. The authors hypothesized that a catheterization threshold of 800 ml was superior to 500 ml in reducing postoperative urinary catheterization and urological complications after fast-track total hip...... and understood Danish. Participants were randomly allocated to a catheterization threshold of 500 or 800 ml, using opaque sealed envelopes. Group assignment was unmasked. Ultrasound bladder scans were performed every second hour until the first voluntary micturition, with subsequent urinary catheterization...

  7. A Comparative Study of Analog Voltage-mode Control Methods for Ultra-Fast Tracking Power Supplies

    DEFF Research Database (Denmark)

    Høyerby, Mikkel Christian Wendelboe; Andersen, Michael Andreas E.

    2007-01-01

    This paper presents a theoretical and experimental comparison of the standard PWM/PID voltage-mode control method for single-phase buck converters with two highperformance self-oscillating (a.k.a. sliding mode) control methods. The application considered is ultra-fast tracking power supplies...... (UFTPSs) for RF power amplifiers, where the switching converter needs to track a varying reference voltage precisely and quickly while maintaining low output impedance. The small-signal analyses performed on the different controllers show that the hysteretic-type controller can achieve the highest loop......-oscillating control is shown to reduce the worst-case UFTPS output impedance by a factor of 10....

  8. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Husted, Henrik; Kehlet, Henrik

    2012-01-01

    Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit....... They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee...... joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p strength training exercises...

  9. Relatives in older patients' fast-track treatment programme during total hip or knee replacement. A grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher

    The aim of this Ph.D.-dissertation was to generate grounded theories of relatives, patients, and health professionals’ pattern of behaviour, respectively, in relation to the relatives of older patients’ fast-track treatment programmes during total hip or knee replacement. The dissertation includes...... three classic grounded theory studies discovered through Glaser’s theoretical and methodological framework. The constant comparative method was the guiding principle of simultaneous data collection, data analysis, and substantive and theoretical coding, while theoretical sampling and writing memos. Data...... and considerate support in concern for the patients; Substituting mode, with practical and cognitive support; and Adapting mode, by trying to fit in with the patients’ and health professionals’ requirements. Study II: 16 patients aged 70 to 94 were included and data was collected through 15 non...

  10. A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board.

    Science.gov (United States)

    Williams, Sophie; Davies, Peter; Johnson, Blair; Iles, Stephen

    2018-03-23

    In 2009, a Respiratory Fast Track Clinic (RFTC) was introduced successfully by Southern District Health Board. Advancing on this model by incorporating further biopsy methods, we aimed to streamline our investigative cancer pathway. The RFTC introduction was bi-phasic with staggered introduction of computed tomography (CT), and then biopsy, to the first service appointment (FSA). Patients with suspected lung cancer were identified for a six-month period preceding the RFTC. The time for the diagnostic pathway was then contrasted to the two RTFC introductory phases. In total, 212 patients were investigated for suspected lung cancer. Endobronchial ultrasound (EBUS) was the most utilised biopsy method. Time from GP referral to FSA improved significantly (p=0.005). Similarly, time from FSA to diagnosis and treatment improved, median times reducing from 15 to 0 (p=improve survival if incorporated into the RFTC model.

  11. First results of the silicon telescope using an 'artificial retina' for fast track finding

    Energy Technology Data Exchange (ETDEWEB)

    Neri, N. [Istituto Nazionale di Fisica Nucleare - INFN, Sezione di Milano, Milano (Italy); Abba, A.; Caponio, F.; Geraci, A.; Grizzuti, M.; Lusardi, N. [INFN Milano and Politecnico di Milano, Milano (Italy); Citterio, M.; Coelli, S.; Fu, J.; Monti, M.; Petruzzo, M. [INFN Milano, Milano (Italy); Bedeschi, F.; Ninci, D.; Piucci, A.; Spinella, F.; Walsh, J. [INFN Pisa, Pisa (Italy); Cenci, R.; Marino, P.; Morello, M. J.; Stracka, S. [INFN Pisa and Scuola Normale Superiore di Pisa, Pisa (Italy); Punzi, G. [INFN Pisa and Universita di Pisa, Pisa (Italy); Tonelli, D. [CERN, Geneva (Switzerland); Ristori, L. [INFN Pisa, Pisa (Italy); Fermilab, Batavia, Illinois (United States)

    2015-07-01

    We present the first results of the prototype of a silicon tracker with trigger capabilities based on a novel approach for fast track finding. The working principle of the 'artificial retina' is inspired by the processing of visual images by the brain and it is based on extensive parallelization of data distribution and pattern recognition. The algorithm has been implemented in commercial FPGAs in three main logic modules: a switch for the routing of the detector hits, a pool of engines for the digital processing of the hits, and a block for the calculation of the track parameters. The architecture is fully pipelined and allows the reconstruction of real-time tracks with a latency less then 100 clock cycles, corresponding to 0.25 microsecond at 400 MHz clock. The silicon telescope consists of 8 layers of single-sided silicon strip detectors with 512 strips each. The detector size is about 10 cm x 10 cm and the strip pitch is 183 μm. The detectors are read out by the Beetle chip, a custom ASICs developed for LHCb, which provides the measurement of the hit position and pulse height of 128 channels. The 'artificial retina' algorithm has been implemented on custom data acquisition boards based on FPGAs Xilinx Kintex 7 lx160. The parameters of the tracks detected are finally transferred to host PC via USB 3.0. The boards manage the read-out ASICs and the sampling of the analog channels. The read-out is performed at 40 MHz on 4 channels for each ASIC that corresponds to a decoding of the telescope information at 1.1 MHz. We report on the first results of the fast tracking device and compare with simulations. (authors)

  12. The impact of a fast track area on quality and effectiveness outcomes: a Middle Eastern emergency department perspective.

    LENUS (Irish Health Repository)

    Devkaran, Subashnie

    2009-01-01

    BACKGROUND: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. METHODS: The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706). RESULTS: Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, P < 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, P < 0.001) post FTA. The mean WTs of urgent patients (CTAS 2\\/3) were also significantly reduced after the FTA was opened (P < 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; P < 0.001). Opening a FTA had no significant impact on mortality rates (P = 0.88). CONCLUSION: The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged.

  13. Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

    Science.gov (United States)

    Tousignant, Michel; Corriveau, Hélène; Kairy, Dahlia; Berg, Katherine; Dubois, Marie-France; Gosselin, Sylvie; Swartz, Richard H; Boulanger, Jean-Martin; Danells, Cynthia

    2014-01-30

    The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost

  14. Fast track NTR systems assessment for NASA's first lunar outpost scenario

    Science.gov (United States)

    Borowski, Stanley K.; Alexander, Stephen W.

    1994-10-01

    Integrated systems and mission study results are presented which quantify the rationale and benefits for developing and using nuclear thermal rocket (NTR) technology for returning humans to the moon in the early 2000's. At present, the Exploration Program Office (ExPO) is considering chemical propulsion for its 'First Lunar Outpost' (FLO) mission, and NTR propulsion for the more demanding Mars missions to follow. The use of an NTR-based lunar transfer stage, capable of evolving to Mars mission applications, could result in an accelerated schedule, reduced cost approach to moon/Mars exploration. Lunar mission applications would also provide valuable operational experience and serve as a 'proving ground' for NTR engine and stage technologies. In terms of performance benefits, studies indicate that an expendable NTR stage powered by two 50 klbf engines can deliver approximately 96 metric tons (t) to trans-lunar injection (TLI) conditions for an initial mass in low earth orbit (IMLEO) of approximately 199 t compared to 250 t for a cryogenic chemical TLI stage. The NTR stage liquid hydrogen (LH2) tank has a 10 m diameter, 14.8 m length, and 68 t LH2 capacity. The NTR utilizes a 'graphite' fuel form consisting of coated UC2 particles in a graphite substrate, and has a specific impulse capability of approximately 870 s, and an engine thrust-to-weight ratio of approximately 4.8. The NTR stage and its piloted FLO lander has a total length of approximately 38 m and can be launched by a single Saturn V-derived heavy lift launch vehicle (HLLV) in the 200 to 250 t-class range. The paper summarizes NASA's First Lunar Outpost scenario, describes characteristics for representative engine/stage configurations, and examines the impact on engine selection and vehicle design resulting from a consideration of alternative NTR fuel forms and lunar mission profiles.

  15. 171. Funcionamiento y resultados del programa de fast-track en el tratamiento de la tetralogía de fallot

    Directory of Open Access Journals (Sweden)

    J. Orrit Palacios

    2010-01-01

    Conclusiones: La corrección completa de la tetralogía de Fallot con el programa de fast-track de anestesia disminuye la ventilación mecánica, la estancia en cuidados intensivos y el tiempo de hospitalización. Asimismo se reducen los costes económicos del tratamiento.

  16. Nurse Practitioners' attitude to nutritional challenges dealing with the patients' nutritional needs and ability to care for themselves in a fast track program

    DEFF Research Database (Denmark)

    Graarup, Jytte; Pedersen, Preben Ulrich; Bjerrum, Merete

    2014-01-01

    Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim is to re...

  17. Fast track management reduces the systemic inflammatory response and organ failure following elective infrarenal aortic aneurysm repair.

    Science.gov (United States)

    Muehling, Bernd M; Ortlieb, Lutz; Oberhuber, Alexander; Orend, Karl Heinz

    2011-05-01

    Systemic inflammatory response syndrome (SIRS) is common after abdominal aortic aneurysm (AAA) repair. The aim of this study was to analyze the impact of a multimodal fast track (FT) regimen on incidence rates of SIRS after elective infrarenal AAA repair. Post hoc analysis of a randomized controlled trial including 99 patients after either traditional (TC) or FT care. Basic FT elements were no bowel preparation, reduced preoperative fasting, patient controlled epidural analgesia, enhanced postoperative feeding and mobilization. The presence of SIRS, organ failure and mortality, length of stay (LOS) on intensive care unit (ICU) were analyzed during the postoperative course. The incidence of SIRS in the FT treatment arm was significantly lower as compared to TC: 28% vs. 50%, P = 0.04. The rate of any organ failure (AOF) and multiple organ failure (MOF) was lower in the FT group: AOF: 16% vs. 36%, P = 0.039; MOF: 2% vs. 12%; P = 0.112. LOS on ICU showed a slight advantage for FT care: 20 hours vs. 32 hours (P = 0.183). An optimized patient care program in elective open AAA repair significantly decreases the postoperative incidence of SIRS as well as rates of organ failure.

  18. Inhibiting Interference - a grounded theory of health professionals' pattern of behaviour related to the relatives of older patients in fast-track treatment programmes

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

    2014-01-01

    AIM: To generate a grounded theory explaining health professionals' pattern of behaviour and experience related to the relatives of older patients in fast-track treatment programmes during total joint replacement. BACKGROUND: Health professionals uphold standardised care for patients, and effect...... on quality is seen when relatives support patients during total joint replacement. Since health professionals often have problematic relationships with relatives, knowledge is needed of the health professionals' pattern of behaviour in relation to relatives of older patients in fast-track treatment programme....... DESIGN: Grounded theory according to Glaser's methodology was used to generate substantive theory of health professionals' pattern of behaviour. METHODS: Data were collected from 2010 to 2011 by 44 health professionals in orthopaedic wards at two Danish hospitals. Data from nonparticipant observations...

  19. Comparison of two modes of ventilation after fast-track cardiac surgery: Adaptive support ventilation versus synchronized intermittent mandatory ventilation

    International Nuclear Information System (INIS)

    Aghadavoudi, O.

    2012-01-01

    Objective: There is substantial debate regarding the appropriate protocol for ventilatory management in fast-track cardiac anesthesia (FTCA). This study was carried out to assess and compare the risks and benefits of respiratory weaning based on adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) after uncomplicated cardiac surgery. Methodology: In a randomized clinical trial, after receiving approval of the Department Research Committee and informed consent from study subjects, 100 patients undergoing elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) were enrolled during a 4-month period at a university-based hospital. After surgery and admission to the intensive care unit (ICU), patients were randomized to ASV and SIMV groups. Arterial blood gas (ABG) and hemodynamic variables, respiratory and ventilator characteristics including lung compliance, rapid shallow breathing index (RSBI), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (P peak), mean airway pressure (p mean), Pao2/FIo2, duration of mechanical ventilation and tracheal intubation, and length of ICU stay were recorded and compared between the two groups. The data were analyzed in 82 patients after considering the exclusion criteria. Results: There were no differences between ASV and SIMV groups in demographics and preoperative characteristics. The duration of tracheal intubation and the length of ICU stay were similar in both groups. There were no statistically and clinically relevant differences between the two groups in ABG, hemodynamic changes, and respiratory and ventilator characteristics during ICU stay. Conclusion: Although ASV may facilitate postoperative respiratory management in FTCA, both ASV and SIMV provide similarly safe and practicable respiratory weaning in the cardiac ICU. The evaluation of potential advantages in patient outcomes and resource utilization of respiratory weaning based on ASV

  20. Safety and efficacy of fast-track surgery in perioperative nursing for biliary calculi surgery: a meta-analysis

    Directory of Open Access Journals (Sweden)

    LI Qinan

    2015-10-01

    Full Text Available ObjectiveTo systematically review the efficacy and safety of fast-track surgery (FTS in perioperative nursing for biliary calculi surgery. MethodsOnline databases of PubMed, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data were comprehensively searched for relevant randomized controlled trials (RCTs. Potential bias was evaluated by Cochrane tools and data were analyzed by RevMan 5.3. ResultsA total of 11 RCTs with 1455 patients were included (738 cases in FTS group and 717 cases in control group. The results of meta-analysis showed that FTS significantly reduced the length of postoperative hospital stay (MD=-4.10, 95% CI: -5.68 to -2.52, P<0.000 01 and hospital costs (MD=-0.47, 95%CI: -0.60 to -0.34, P<0.000 01; meanwhile, FTS shortened the time to gastrointestinal recovery (SMD=-2.05, 95%CI: -2.84 to -1.27, P<0.000 01, as well as the time to first defecation (SMD=-1.27, 95% CI: -2.08 to -0.46, P<0.000 01. As for safety, FTS significantly reduced the total complications of choledocholithiasis (RR=0.53, 95%CI: 0.43-0.65, P<0.000 01 and hepatolithiasis (RR=0.52, 95% CI: 0.35-0.77, P=0.001. ConclusionFTS is effective and safe in perioperative nursing for biliary calculi surgery. It can significantly reduce the length of postoperative hospital stay, enhance gastrointestinal recovery, shorten the time to first defecation, and reduce total complications.

  1. Beyond trend analysis: How a modified breakpoint analysis enhances knowledge of agricultural production after Zimbabwe's fast track land reform

    Science.gov (United States)

    Hentze, Konrad; Thonfeld, Frank; Menz, Gunter

    2017-10-01

    In the discourse on land reform assessments, a significant lack of spatial and time-series data has been identified, especially with respect to Zimbabwe's ;Fast-Track Land Reform Programme; (FTLRP). At the same time, interest persists among land use change scientists to evaluate causes of land use change and therefore to increase the explanatory power of remote sensing products. This study recognizes these demands and aims to provide input on both levels: Evaluating the potential of satellite remote sensing time-series to answer questions which evolved after intensive land redistribution efforts in Zimbabwe; and investigating how time-series analysis of Normalized Difference Vegetation Index (NDVI) can be enhanced to provide information on land reform induced land use change. To achieve this, two time-series methods are applied to MODIS NDVI data: Seasonal Trend Analysis (STA) and Breakpoint Analysis for Additive Season and Trend (BFAST). In our first analysis, a link of agricultural productivity trends to different land tenure regimes shows that regional clustering of trends is more dominant than a relationship between tenure and trend with a slightly negative slope for all regimes. We demonstrate that clusters of strong negative and positive productivity trends are results of changing irrigation patterns. To locate emerging and fallow irrigation schemes in semi-arid Zimbabwe, a new multi-method approach is developed which allows to map changes from bimodal seasonal phenological patterns to unimodal and vice versa. With an enhanced breakpoint analysis through the combination of STA and BFAST, we are able to provide a technique that can be applied on large scale to map status and development of highly productive cropping systems, which are key for food production, national export and local employment. We therefore conclude that the combination of existing and accessible time-series analysis methods: is able to achieve both: overcoming demonstrated limitations of

  2. Why do 'fast track' patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay.

    Science.gov (United States)

    Gill, Stephen D; Lane, Stephen E; Sheridan, Michael; Ellis, Elizabeth; Smith, Darren; Stella, Julian

    2018-03-23

    Low-acuity 'fast track' patients represent a large portion of Australian EDs' workload and must be managed efficiently to meet the National Emergency Access Target. The current study determined the relative importance and estimated marginal effects of patient and system-related variables in predicting ED fast track patients who stayed longer than 4 h in the ED. Data for ED presentations between 1 July 2014 and 30 June 2015 were collected from a large regional Australian public hospital. Only 'fast track' patients were included in the analysis. A gradient boosting machine was used to predict which patients would have an ED length of stay greater or less than 4 h. The performance of the final model was tested using a validation data set that was withheld from the initial analysis. A total of 27 variables were analysed. The model's performance was very good (area under receiver operating characteristic curve 0.89, where 1.0 is perfect prediction). The five most important variables for predicting length of stay were time-dependent and system-related (not patient-related); these were the amount of time taken from when the patient arrived at the ED to: (i) order imaging; (ii) order pathology; (iii) request admission to hospital; (iv) allocate a clinician to care for the patient; and (v) handover a patient between ED clinicians. We identified the most important variables for predicting length of stay greater than 4 h for fast track patients in our ED. Identifying factors that influence length of stay is a necessary step towards understanding ED patient flow and identifying improvement opportunities. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  3. Stroke Stories | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Stroke Stories Past Issues / Spring 2013 Table of Contents ... these well-known personalities suffered one or more strokes. In each case, he or she has returned ...

  4. Good practice in occupational health services – Certification of stroke as an accident at work. Need for secondary prevention in people returning to work after acute cerebrovascular events

    OpenAIRE

    Andrzej Marcinkiewicz; Jolanta Walusiak-Skorupa

    2015-01-01

    The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache,...

  5. What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

    Directory of Open Access Journals (Sweden)

    John Stover

    Full Text Available In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually-far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before

  6. Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial.

    Science.gov (United States)

    Feng, Fan; Li, Xiao Hua; Shi, Hai; Wu, Guo Sheng; Zhang, Hong Wei; Liu, Xiao Nan; Zhao, Qing Chuan

    2014-06-01

    In this study we aimed to assess the feasibility and safety of fast-track surgery (FTS) combined with laparoscopy for treating patients with rectal cancer and compare the results with those of the conventional perioperative intervention group. A total of 120 patients with rectal cancer were prospectively randomly assigned to the FTS combined with laparoscopy group and the conventional perioperative intervention plus laparoscopy group from November 2011 to November 2012. All patients received radical anterior resection with total mesorectal excision. Their baseline characteristics and the perioperative outcomes were recorded for analyses. Compared with the conventional perioperative intervention group, the fast-track protocol combined with laparoscopy could shorten the time to the first flatus (53.44 ± 23.64 h vs 67.85 ± 20.12 h, P = 0.001) and first defecation (65.23 ± 22.24 h vs 86.98 ± 24.85 h, P = 0.000) after operation, accelerate the decrease of white blood cell count (P laparoscopy may accelerate the clinical recovery of patients with rectal cancer after surgery. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  7. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  8. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    . Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking......BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...

  9. Diagnostic methods for fast-track identification of endometrial cancer in women with postmenopausal bleeding and endometrial thickness greater than 5 mm

    DEFF Research Database (Denmark)

    Dueholm, Margit; Marinowskij, Edvard; Hansen, Estrid Stæhr

    2015-01-01

    efficiency (area under the curve) for malignancy diagnosis (ES, 0.90; TVS, 0.88; GIS, 0.92; HYpattern, 0.91). When insufficient samples were incorporated, ES was less efficient than the other techniques. ES was not more efficient in the subgroup of women without localized lesions than in the subgroup...... of women with localized lesions. MRI and HYpattern added limited efficiency, whereas hysteroscopy with biopsy was most efficient. CONCLUSIONS: As a first-line technique, pattern recognition on TVS, GIS, and HYpattern correctly identifies 9 of 10 women with malignancy and is superior to pattern recognition...... on ES when insufficient samples are included. Endometrial pattern evaluated with TVS and GIS is a fast and efficient first-line diagnostic tool that outperforms ES in women with or without localized lesions. Malignant patterns on TVS/GIS should warrant fast-track evaluation, whereas women with benign...

  10. Implantación de un protocolo Fast-Track en cistectomía radical en una hospital terciario: Resultados

    OpenAIRE

    Ortega Lucea, Sonia María; Martínez Ubieto, Javier

    2014-01-01

    Introducción La cistectomía radical más linfadenectomía es el tratamiento de elección del tumor vesical músculo invasivo, siendo el procedimiento urológico asociado a las tasas más altas de morbimortalidad y estancia hospitalaria. La aplicación de programas de recuperación multimodal mejorada o ¿fast-track¿ pretende acelerar la recuperación postquirúrgica sin aumentar la morbilidad y su aplicación a la cistectomía radical ha reportado también resultados positivos1 Objetivos Se plantea este es...

  11. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...

  12. Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C.; Kehlet, Henrik; Husted, Henrik

    2017-01-01

    Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies.  Patients and meth......Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies.  Patients...... and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients...

  13. Fast track segment finding in the Monitored Drift Tubes (MDT) of the ATLAS Muon Spectrometer using a Legendre transform algorithm

    CERN Document Server

    Ntekas, Konstantinos; The ATLAS collaboration

    2018-01-01

    Many of the physics goals of ATLAS in the High Luminosity LHC era, including precision studies of the Higgs boson, require an unprescaled single muon trigger with a 20 GeV threshold. The selectivity of the current ATLAS first-level muon trigger is limited by the moderate spatial resolution of the muon trigger chambers. By incorporating the precise tracking of the MDT, the muon transverse momentum can be measured with an accuracy close to that of the offline reconstruction at the trigger level, sharpening the trigger turn-on curves and reducing the single muon trigger rate. A novel algorithm is proposed which reconstructs segments from MDT hits in an FPGA and find tracks within the tight latency constraints of the ATLAS first-level muon trigger. The algorithm represents MDT drift circles as curves in the Legendre space and returns one or more segment lines tangent to the maximum possible number of drift circles.  This algorithm is implemented without the need of resource and time consuming hit position calcul...

  14. Study Protocol: Phase III single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease

    Directory of Open Access Journals (Sweden)

    Brafman-Kennedy Barbara

    2011-05-01

    Full Text Available Abstract Background Breathlessness in advanced disease causes significant distress to patients and carers and presents management challenges to health care professionals. The Breathlessness Intervention Service (BIS seeks to improve the care of breathless patients with advanced disease (regardless of cause through the use of evidence-based practice and working with other healthcare providers. BIS delivers a complex intervention (of non-pharmacological and pharmacological treatments via a multi-professional team. BIS is being continuously developed and its impact evaluated using the MRC's framework for complex interventions (PreClinical, Phase I and Phase II completed. This paper presents the protocol for Phase III. Methods/Design Phase III comprises a pragmatic, fast-track, single-blind randomised controlled trial of BIS versus standard care. Due to differing disease trajectories, the service uses two broad service models: one for patients with malignant disease (intervention delivered over two weeks and one for patients with non-malignant disease (intervention delivered over four weeks. The Phase III trial therefore consists of two sub-protocols: one for patients with malignant conditions (four week protocol and one for patients with non-malignant conditions (eight week protocol. Mixed method interviews are conducted with patients and their lay carers at three to five measurement points depending on randomisation and sub-protocol. Qualitative interviews are conducted with referring and non-referring health care professionals (malignant disease protocol only. The primary outcome measure is 'patient distress due to breathlessness' measured on a numerical rating scale (0-10. The trial includes economic evaluation. Analysis will be on an intention to treat basis. Discussion This is the first evaluation of a breathlessness intervention for advanced disease to have followed the MRC framework and one of the first palliative care trials to use fast

  15. A stochastic frontier analysis of technical efficiency in smallholder maize production in Zimbabwe: The post-fast-track land reform outlook

    Directory of Open Access Journals (Sweden)

    Nelson Mango

    2015-12-01

    Full Text Available This article analyses the technical efficiency of maize production in Zimbabwe’s smallholder farming communities following the fast-track land reform of the year 2000 with a view of highlighting key entry points for policy. Using a randomly selected sample of 522 smallholder maize producers, a stochastic frontier production model was applied, using a linearised Cobb–Douglas production function to determine the production elasticity coefficients of inputs, technical efficiency and the determinants of efficiency. The study finds that maize output responds positively to increases in inorganic fertilisers, seed quantity, the use of labour and the area planted. The technical efficiency analysis suggests that about 90% of farmers in the sample are between 60 and 75% efficient, with an average efficiency in the sample of 65%. The significant determinants of technical efficiency were the gender of the household head, household size, frequency of extension visits, farm size and the farming region. The results imply that the average efficiency of maize production could be improved by 35% through better use of existing resources and technology. The results highlight the need for government and private sector assistance in improving efficiency by promoting access to productive resources and ensuring better and more reliable agricultural extension services.

  16. Fast track consultation in the infectious diseases department of a French university hospital: evaluation of the service delivered to the general practitioner.

    Science.gov (United States)

    Weiss, Nicolas; Courjon, Johan; Pradier, Christian; Caisso, Cécile; Mondain, Véronique; Roger, Pierre-Marie; Demonchy, Elisa

    2018-02-01

    Since 2010, the Infectious Diseases (ID) department of the Nice university hospital (France) has implemented a fast track consultation (FTC): it allows General Practitioners (GP) to directly reach an ID specialist through a dedicated phone number for initial advice. Depending on the first observation, a formal consultation can be planned within 48 h. Our aim was to evaluate in a pilot study, the contribution of the FTC regarding the management of patients 28 days after the first phone contact. This prospective current care study was conducted between November 2014 and January 2015 in our ID department. The GP indicates the most likely diagnosis, the therapeutic strategy and the patient's management he would have applied. After the formal consultation, ID specialist provides his diagnosis, therapeutic strategy and patient's management. An adjudicative committee has evaluated the benefit of the FTC after 28 days of follow-up. Fifty-one patients referred by 49 GP were included. ID specialists modified the diagnosis in 22 (43%) patients, antibiotic treatment in 35 (68%) and treatment plan in 30 patients (59%). FTC provided at least one service for 41/51 patients (94%): antibiotic treatment was reassessed for 11 (22%) patients, averted for 9 (18%) patients, unnecessary hospitalization was avoided for 8 (16%) of them and emergency room visit averted for 5 (10%) patients. FTC can provide significant improvement in the management of the patients in terms of decrease in unnecessary hospitalization, emergency room visit averted and appropriate use of antibiotics.

  17. China's challenging fast track. Far more energy will have to be produced - and conserved - to power the expanding economy and protect the environment

    International Nuclear Information System (INIS)

    Wei Zhihong

    2004-01-01

    China's economy is on a fast track, with growth projected to quadruple in the first two decades of this century. A mix of clean and affordable energy sources will be needed to fuel and sustain development. Since China opened to outside markets in the 1980s, the national economy has expanded steadily, with an average annual growth rate of 9.6% in gross domestic product (GDP) from 1980 to 2000. Development has stayed strong in this century, and GDP grew 9.1% in 2003, the highest rate in the past six years. For the first time, per capita GDP topped $1000, reaching $1090 last year. How to best manage and sustain growth is driving energy decisions. Analyses show that China has entered a stage of manufacturing, chemical, and heavy industrial development that is energy intensive. At the same time, demands for energy at home and in businesses are growing among China's population of 1.3 billion people. As consumption grows, so do concerns about air, water, and land pollution in the context of sustainable energy development

  18. Preventing stroke

    Science.gov (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  19. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  20. Fast tracking using edge histograms

    Science.gov (United States)

    Rokita, Przemyslaw

    1997-04-01

    This paper proposes a new algorithm for tracking objects and objects boundaries. This algorithm was developed and applied in a system used for compositing computer generated images and real world video sequences, but can be applied in general in all tracking systems where accuracy and high processing speed are required. The algorithm is based on analysis of histograms obtained by summing along chosen axles pixels of edge segmented images. Edge segmentation is done by spatial convolution using gradient operator. The advantage of such an approach is that it can be performed in real-time using available on the market hardware convolution filters. After edge extraction and histograms computation, respective positions of maximums in edge intensity histograms, in current and previous frame, are compared and matched. Obtained this way information about displacement of histograms maximums, can be directly converted into information about changes of target boundaries positions along chosen axles.

  1. ATLAS FTK: Fast Track Trigger

    CERN Document Server

    Amerio, S; The ATLAS collaboration; Andreazza, A; Annovi, A; Beretta, M; Bevacqua, V; Bogdan, M; Bossini, E; Boveia, A; Cavaliere, V; Canelli, F; Blazey, G; Cervigni, F; Cheng, Y; Citterio, M; Crescioli, F; Dell’Orso, M; Drake, G; Dunford, M; Giannetti, P; Giorgi, F; Hoff, J; Kapliy, A; Kasten, M; Kim, Y K; Kimura, N; Lanza, A; Liberali, V; Liu, T; Magalotti, D; McCarn, A; Melachrinos, C; Meroni, C; Negri, A; Neubauer, M; Penning, B; Piendibene, M; Proudfoot, J; Riva, M; Roda, C; Sabatini, F; Sacco, I; Shochet, M; Stabile, A; Tang, F; Tang, J; Tripiccione, R; Tuggle, J; Vercesi, V; Verzocchi, M; Villa, M; Vitillo, R A; Volpi, G; Webster, J; Wu, J; Yorita, K; Zhang, J

    2011-01-01

    A track reconstruction system for the trigger of the ATLAS detector at the Large Hadron Collider is described. The Fast Tracker is a highly parallel hardware system designed to operate at the Level-1 trigger output rate. It will provide high-quality tracks reconstructed over the entire inner detector by the start of processing in the Level-2 trigger. The system is based on associative memories for pattern recognition and fast FPGA’s for track reconstruction. Its design and expected performance under instantaneous luminosities up to 3 × 10^34/cm^2/s are discussed.

  2. ATLAS FTK: Fast Track Trigger

    CERN Document Server

    Volpi, Guido; The ATLAS collaboration

    2015-01-01

    An overview of the ATLAS Fast Tracker processor is presented, reporting the design of the system, its expected performance, and the integration status. The next LHC runs, with a significant increase in instantaneous luminosity, will provide a big challenge to the trigger and data acquisition systems of all the experiments. An intensive use of the tracking information at the trigger level will be important to keep high efficiency in interesting events, despite the increase in multiple p-p collisions per bunch crossing (pile-up). In order to increase the use of tracks within the High Level Trigger (HLT), the ATLAS experiment planned the installation of an hardware processor dedicated to tracking: the Fast TracKer (FTK) processor. The FTK is designed to perform full scan track reconstruction at every Level-1 accept. To achieve this goal, the FTK uses a fully parallel architecture, with algorithms designed to exploit the computing power of custom VLSI chips, the Associative Memory, as well as modern FPGAs. The FT...

  3. Stem Cell Recipes of Bone Marrow and Fish: Just What the Stroke Doctors Ordered.

    Science.gov (United States)

    Napoli, Eleonora; Borlongan, Cesar V

    2017-04-01

    Stem cell therapy for stroke has advanced from the laboratory to the clinic, but remains as an experimental treatment. Two lines of transplant regimens have emerged, namely the "early bird" peripheral injections in subacute stroke patients and the "late night" direct intracerebral treatments in chronic stroke patients. Autologous bone marrow-derived stem cells, which only required minimal manipulations during graft cell preparation, gained fast-track entry into the clinic, while gene modified stem cells necessitated overcoming more stringent regulatory criteria before they were approved for clinical use. Safety of the stem cell therapy can be declared from these clinical trials, but efficacy warrants further investigations. Here, we offer insights into the translation of cell therapy from the laboratory to the clinic, in the hopes that highlighting the lessons we learned from this experience will guide the optimization of functional outcomes of future clinical trials of stem cell therapy for stroke.

  4. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  5. Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-09-01

    Full Text Available Abstract Background The two major complications of atherosclerosis are acute myocardial infarction (AMI and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method A literature search was performed on the PubMed, Embase (Ovid SP and Cochrane Library databases. Results In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women. With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between

  6. Perceived confidence relates to driving habits post-stroke.

    Science.gov (United States)

    McNamara, Annabel; Walker, Ruth; Ratcliffe, Julie; George, Stacey

    2015-01-01

    Returning to driving post-stroke is a step towards independence. On return to driving following stroke, confidence is related to performance in on-road assessment and self-regulation of driving behaviours occurs. The aim of this study was to examine the relationship between driver's confidence and driving habits post-stroke. Structured telephone surveys were completed with 40 stroke survivors (62% men), of mean age 65 years SD 12.17 who returned to driving post-stroke within the previous 3 years. The survey included: (1) socio-demographics, (2) Adelaide Driving Self Efficacy Scale (ADSES) and (3) Driving Habits Questionnaire (DHQ). Male stroke survivors were more likely to return to driving, drive further and more often. Stroke survivors under 65 years were likely to drive further. Driving confidence was significantly associated with kilometres driven (p = 0.006), distance driven (p = 0.027) and self-limiting driving (p = 0.00). Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life. Implications for Rehabilitation Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

  7. Development, effectiveness and cost-effectiveness of a new out-patient Breathlessness Support Service: study protocol of a phase III fast-track randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Bausewein Claudia

    2012-09-01

    Full Text Available Abstract Background Breathlessness is a common and distressing symptom affecting many patients with advanced disease both from malignant and non-malignant origin. A combination of pharmacological and non-pharmacological measures is necessary to treat this symptom successfully. Breathlessness services in various compositions aim to provide comprehensive care for patients and their carers by a multiprofessional team but their effectiveness and cost-effectiveness have not yet been proven. The Breathlessness Support Service (BSS is a newly created multiprofessional and interdisciplinary outpatient service at a large university hospital in South East London. The aim of this study is to develop and evaluate the effectiveness and cost effectiveness of this multidisciplinary out–patient BSS for the palliation of breathlessness, in advanced malignant and non-malignant disease. Methods The BSS was modelled based on the results of qualitative and quantitative studies, and systematic literature reviews. A randomised controlled fast track trial (RCT comprising two groups: 1 intervention (immediate access to BSS in addition to standard care; 2 control group (standard best practice and access to BSS after a waiting time of six weeks. Patients are included if suffering from breathlessness on exertion or at rest due to advanced disease such as cancer, chronic obstructive pulmonary disease (COPD, chronic heart failure (CHF, interstitial lung disease (ILD or motor neurone disease (MND that is refractory to maximal optimised medical management. Both quantitative and qualitative outcomes are assessed in face to-face interviews at baseline, after 6 and 12 weeks. The primary outcome is patients' improvement of mastery of breathlessness after six weeks assessed on the Chronic Respiratory Disease Questionnaire (CRQ. Secondary outcomes for patients include breathlessness severity, symptom burden, palliative care needs, service use, and respiratory measures (spirometry

  8. Returning home

    DEFF Research Database (Denmark)

    Agergaard, Jytte; Brøgger, Ditte

    2016-01-01

    flows. By focusing on these educational migrants, this paper explores how they connect to their rural homes. Guided by a critical reading of the migration-development scholarship, the paper examines how migrants and their relatives make sense of educational migrants’ remitting and returning practices......, and by comparing three groups of educational migrants, the migrants’ reasons for staying connected and sending remittances are scrutinized. The paper finds that although educational migrants do not generate extensive economic remittances for local development in Nepal, they stay connected to their rural homes...

  9. Gold Returns

    OpenAIRE

    Robert J. Barro; Sanjay P. Misra

    2013-01-01

    From 1836 to 2011, the average real rate of price change for gold in the United States is 1.1% per year and the standard deviation is 13.1%, implying a one-standard-deviation confidence band for the mean of (0.1%, 2.1%). The covariances of gold's real rate of price change with consumption and GDP growth rates are small and statistically insignificantly different from zero. These negligible covariances suggest that gold's expected real rate of return--which includes an unobserved dividend yiel...

  10. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  11. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  12. Dysphagia in Stroke: A New Solution

    OpenAIRE

    Langdon, Claire; Blacker, David

    2010-01-01

    Dysphagia is extremely common following stroke, affecting 13%–94% of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. While many stroke survivors experience a rapid return to normal swallowing function, this does not always happen. Current dysphagia treatment in Australia focuses upon prevention of aspiration via diet and fluid modifications, compensato...

  13. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

    Science.gov (United States)

    Jauch, Edward C; Cucchiara, Brett; Adeoye, Opeolu; Meurer, William; Brice, Jane; Chan, Yvonne Yu-Feng; Gentile, Nina; Hazinski, Mary Fran

    2010-11-02

    Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

  14. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  15. In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage: A prospective, double-blinded, randomized, placebo controlled trial.

    Science.gov (United States)

    van Beek, Rienk; Zonneveldt, Harry J; van der Ploeg, Tjeerd; Steens, Jeroen; Lirk, Phillip; Hollmann, Marcus W

    2017-07-01

    Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol. The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study. We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting. In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.

  16. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  17. Stroke Rehabilitation

    Science.gov (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  18. Pediatric Stroke

    Science.gov (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

  19. Product Return Handling

    OpenAIRE

    de Brito, M.P.; de Koster, M.B.M.

    2003-01-01

    textabstractIn this article we focus on product return handling and warehousing issues. In some businesses return rates can be well over 20% and returns can be especially costly when not handled properly. In spite of this, many managers have handled returns extemporarily. The fact that quantitative methods barely exist to support return handling decisions adds to this. In this article we bridge those issues by 1) going over the key decisions related with return handling; 2) identifying quanti...

  20. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  1. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  2. Product Return Handling

    NARCIS (Netherlands)

    M.P. de Brito (Marisa); M.B.M. de Koster (René)

    2003-01-01

    textabstractIn this article we focus on product return handling and warehousing issues. In some businesses return rates can be well over 20% and returns can be especially costly when not handled properly. In spite of this, many managers have handled returns extemporarily. The fact that quantitative

  3. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  4. Driving After a Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  5. Lost Productivity in Stroke Survivors: An Econometrics Analysis.

    Science.gov (United States)

    Vyas, Manav V; Hackam, Daniel G; Silver, Frank L; Laporte, Audrey; Kapral, Moira K

    2016-01-01

    Stroke leads to a substantial societal economic burden. Loss of productivity among stroke survivors is a significant contributor to the indirect costs associated with stroke. We aimed to characterize productivity and factors associated with employability in stroke survivors. We used the Canadian Community Health Survey 2011-2012 to identify stroke survivors and employment status. We used multivariable logistic models to determine the impact of stroke on employment and on factors associated with employability, and used Heckman models to estimate the effect of stroke on productivity (number of hours worked/week and hourly wages). We included data from 91,633 respondents between 18 and 70 years and identified 923 (1%) stroke survivors. Stroke survivors were less likely to be employed (adjusted OR 0.39, 95% CI 0.33-0.46) and had hourly wages 17.5% (95% CI 7.7-23.7) lower compared to the general population, although there was no association between work hours and being a stroke survivor. We found that factors like older age, not being married, and having medical comorbidities were associated with lower odds of employment in stroke survivors in our sample. Stroke survivors are less likely to be employed and they earn a lower hourly wage than the general population. Interventions such as dedicated vocational rehabilitation and policies targeting return to work could be considered to address this lost productivity among stroke survivors. © 2016 S. Karger AG, Basel.

  6. Predictability of Stock Returns

    Directory of Open Access Journals (Sweden)

    Ahmet Sekreter

    2017-06-01

    Full Text Available Predictability of stock returns has been shown by empirical studies over time. This article collects the most important theories on forecasting stock returns and investigates the factors that affecting behavior of the stocks’ prices and the market as a whole. Estimation of the factors and the way of estimation are the key issues of predictability of stock returns.

  7. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...... not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat...

  8. Persistent post-stroke dysphagia treated with cricopharyngeal myotomy

    Directory of Open Access Journals (Sweden)

    Sruthi S Nair

    2016-01-01

    Full Text Available Post-stroke dysphagia is a common problem after stroke. About 8-13% patients have persistent dysphagia and are unable to return to pre-stroke diet even after 6 months of stroke. Use of percutaneous endoscopic gastrostomy (PEG may be required in these patients, which may be psychologically unacceptable and impair the quality of life. In those with cricopharyngeal dysfunction leading on to refractory post-stroke dysphagia, cricopharyngeal myotomy and injection of botulinum toxin are the treatment options. We present a case of vertebrobasilar stroke who had persistent dysphagia due to cricopharyngeal dysfunction with good recovery of swallowing function following cricopharyngeal myotomy 1.5 years after the stroke.

  9. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  10. Predictable return distributions

    DEFF Research Database (Denmark)

    Pedersen, Thomas Quistgaard

    This paper provides detailed insights into predictability of the entire stock and bond return distribution through the use of quantile regression. This allows us to examine speci…c parts of the return distribution such as the tails or the center, and for a suf…ciently …ne grid of quantiles we can...... trace out the entire distribution. A univariate quantile regression model is used to examine stock and bond return distributions individually, while a multivariate model is used to capture their joint distribution. An empirical analysis on US data shows that certain parts of the return distributions...... are predictable as a function of economic state variables. The results are, however, very different for stocks and bonds. The state variables primarily predict only location shifts in the stock return distribution, while they also predict changes in higher-order moments in the bond return distribution. Out...

  11. Classifying Returns as Extreme

    DEFF Research Database (Denmark)

    Christiansen, Charlotte

    2014-01-01

    I consider extreme returns for the stock and bond markets of 14 EU countries using two classification schemes: One, the univariate classification scheme from the previous literature that classifies extreme returns for each market separately, and two, a novel multivariate classification scheme...... that classifies extreme returns for several markets jointly. The new classification scheme holds about the same information as the old one, while demanding a shorter sample period. The new classification scheme is useful....

  12. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  14. Preventing Stroke Deaths

    Science.gov (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  15. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  16. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  17. FATRAS - the ATLAS Fast Track Simulation project

    NARCIS (Netherlands)

    Mechnich, J.

    2011-01-01

    The Monte Carlo simulation of the detector response is an integral component of any analysis performed with data from the LHC experiments. As these simulated data sets must be both large and precise, their production is a CPU-intensive task. ATLAS has developed full and fast detector simulation

  18. What is the fast track to future energy systems with lower CO2 emissions? Main findings and recommendations from Workshop on Future Energy Systems, Technical University of Denmark, 19 - 20 November 2008

    Energy Technology Data Exchange (ETDEWEB)

    Soenderberg Petersen, L.; Larsen, Hans (eds.)

    2009-04-15

    As part of the DTU Climate Change Technologies programme, DTU arranges a series of workshops and conferences on climate change technology focusing on assessment of and adaptation to climate changes as well as on mitigation of green house gasses (GHG). Each workshop target a specific problem area. This workshop focuses on the challenges for the future energy system from a Danish perspective as well as world wide with regard to both technology needs and policy measures with particular focus on identifying a fast track to energy systems with lower CO{sub 2} emissions. In the coming years, energy systems will be changed to consist of a combination of central units and smaller decentralized units - to a large extent based on renewable energy. At the same time there will be close links between the supply of energy and the individual end user of energy. These links will be based on extensive use of information and communication technology. This will allow end users to respond adequately to price signals and use the electricity for loading electric cars, laundry etc. while the electricity prices are low due to for example surplus of wind generated electricity. The workshop assessed the perspectives for a rapid development of energy systems with more renewable energy in order to reduce CO{sub 2} emissions. Furthermore, the workshop gives recommendations for the implementation of such energy systems. The recommendations are targeted at the research community, industry and public authorities. The recommendations include opportunities for synergy between the research community, the government and the energy industry as well as public authorities. This report presents summary and recommendations from the workshop. (au)

  19. Understanding Life After Stroke

    OpenAIRE

    Hjelmblink, Finn

    2008-01-01

    Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...

  20. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

  1. The Reference Return Ratio

    DEFF Research Database (Denmark)

    Nicolaisen, Jeppe; Faber Frandsen, Tove

    2008-01-01

    The paper introduces a new journal impact measure called The Reference Return Ratio (3R). Unlike the traditional Journal Impact Factor (JIF), which is based on calculations of publications and citations, the new measure is based on calculations of bibliographic investments (references) and returns...

  2. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  3. Stroke care: Experiences and clinical research in stroke units in Chennai

    Directory of Open Access Journals (Sweden)

    Gobindram Arjundas

    2006-01-01

    Full Text Available Background: S troke is the second commonest cause of death in India with crude overall prevalence rate of 220 per 100,000. With an increasing aging population at risk, the stroke burden in India can be expected to reach epidemic proportions. Materials and Methods: The first protocol-based prospective studies, funded by private agencies was conducted in Madras Institute of Neurology in 1984-86. The results led to establishment of the first stroke unit in Tamil Nadu state, in the institute. The first all-India hospital-based studies in acute stroke was completed as INDIAN COOPERATIVE ACUTE STROKE STUDIES (ICASS I and ICASS II with WHO STEP ONE by members of the Indian Stroke Association between 2000-2005. This has generated very useful data for our country. Results: Mortality in 1984-86 was 40%. Stroke unit in the institute dropped it to 12%. About 10 years later, ICASS studies showed a further fall of mortality to 8%, which is the current international figure in the west. Morbidity pattern showed about half return to their original activities. But about one third are left totally disabled needing prolonged care, for which fiscal, social and rehab provisions have to be done on a national basis. Conclusions: The progress and success of care of Stroke in the last three decades, from treatment in medical and neurology wards to specialized stroke units is presented. The main risk factors are hypertension, diabetes and ischemic heart disease across the country. Hypertension alone or with the other two diseases was present in 72% of cases. Prevention and treatment of these factors will reduce the stroke burden, mortality and morbidity of strokes. The Stroke-team concept can be extended to the smallest hospitals in our country.

  4. Lidar 2009 - All Returns

    Data.gov (United States)

    Kansas Data Access and Support Center — LIDAR-derived binary (.las) files containing classified points of all returns. We have 3 classifications Unclassified, Ground, Low points. The average Ground Sample...

  5. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  6. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  7. Return to Bangka Island.

    Science.gov (United States)

    Spence, J

    2001-07-01

    This article is a return in a couple of ways to one of the most tragic events in the history of Australian military nursing. Firstly, it describes how the evacuation of nurses from Singapore in 1941 led to circumstances that resulted in the massacre or internment of many of those women. Then in 1993, a group of surviving World War II nurses and current serving Australian Army nurses returned to the site of their sorrow.

  8. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  9. Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals.

    Science.gov (United States)

    Prust, Margaret L; Banda, Clement K; Nyirenda, Rose; Chimbwandira, Frank; Kalua, Thokozani; Jahn, Andreas; Eliya, Michael; Callahan, Katie; Ehrenkranz, Peter; Prescott, Marta R; McCarthy, Elizabeth A; Tagar, Elya; Gunda, Andrews

    2017-07-21

    In order to facilitate scale-up of antiretroviral therapy (ART) in Malawi, innovative and pragmatic models have been developed to optimize the efficiency of HIV service delivery. In particular, three models of differentiated care have emerged for stable patients: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where group members rotate in collecting medications at the facility for all members. This study aimed to assess the extent to which ART patients in Malawi are differentiated based on clinical stability and describe the characteristics and costs associated with the models of differentiated care offered. A mixed methods process evaluation was conducted from 30 purposefully selected ART facilities. Cross-sectional data for this evaluation was collected between February and May 2016. The following forms of data collection are reported here: structured surveys with 136 health care workers; reviews of 75,364 patient clinical records; 714 observations of visit time and flow; and 30 questionnaires on facility characteristics. Among ART patients, 77.5% (95% confidence interval [CI] 74.1-80.6) were eligible for differentiated models of care based on criteria for clinical stability from national guidelines. Across all facilities, 69% of patients were receiving MMS. In facilities offering FTRs and CAGs, 67% and 6% of patients were enrolled in the models, respectively. However, eligibility criteria were used inconsistently: 72.9% (95% CI 66.3-78.6) of eligible patients and 42.3% (95% CI 33.1-52.0) ineligible patients received MMS. Results indicated that patient travel and time costs were reduced by 67%, and the unit costs of ART service delivery through the MMS, FTR and CAG models were similar, representing a reduction of approximately 10% in the annual unit cost of providing care to stable patients that receive no model. MMS is being implemented nationally and has

  10. Ischemic stroke destabilizes circadian rhythms

    Directory of Open Access Journals (Sweden)

    Borjigin Jimo

    2008-10-01

    Full Text Available Abstract Background The central circadian pacemaker is a remarkably robust regulator of daily rhythmic variations of cardiovascular, endocrine, and neural physiology. Environmental lighting conditions are powerful modulators of circadian rhythms, but regulation of circadian rhythms by disease states is less clear. Here, we examine the effect of ischemic stroke on circadian rhythms in rats using high-resolution pineal microdialysis. Methods Rats were housed in LD 12:12 h conditions and monitored by pineal microdialysis to determine baseline melatonin timing profiles. After demonstration that the circadian expression of melatonin was at steady state, rats were subjected to experimental stroke using two-hour intralumenal filament occlusion of the middle cerebral artery. The animals were returned to their cages, and melatonin monitoring was resumed. The timing of onset, offset, and duration of melatonin secretion were calculated before and after stroke to determine changes in circadian rhythms of melatonin secretion. At the end of the monitoring period, brains were analyzed to determine infarct volume. Results Rats demonstrated immediate shifts in melatonin timing after stroke. We observed a broad range of perturbations in melatonin timing in subsequent days, with rats exhibiting onset/offset patterns which included: advance/advance, advance/delay, delay/advance, and delay/delay. Melatonin rhythms displayed prolonged instability several days after stroke, with a majority of rats showing a day-to-day alternation between advance and delay in melatonin onset and duration. Duration of melatonin secretion changed in response to stroke, and this change was strongly determined by the shift in melatonin onset time. There was no correlation between infarct size and the direction or amplitude of melatonin phase shifting. Conclusion This is the first demonstration that stroke induces immediate changes in the timing of pineal melatonin secretion, indicating

  11. Another return to "Return to Equilibrium"

    CERN Document Server

    Fröhlich, J

    2003-01-01

    The property of ``return to equilibrium'' is established for a class of quantum-mechanical models describing interactions of a (toy) atom with black-body radiation, or of a spin with a heat bath of scalar bosons, under the assumption that the interaction strength is sufficiently weak, but independent of temperature $T$, (with $0

  12. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. The Returns to Entrepreneurship

    DEFF Research Database (Denmark)

    Van Praag, Mirjam; Raknerud, Arvid

    Empirical studies show low pecuniary returns of switching from wage employment to entrepreneurship. We reconsider the pecuniary gains of this switching by employing a two-stage procedure, where the randomness in the timing of inheritance transfers is used as an exclusion restriction to identify...... causal effects. The model is estimated on data covering the whole Norwegian population of individuals matched to the entire population of firms established in the period 2002-2011. The results indicate that the average returns to entrepreneurship are significantly negative for individuals entering...... entrepreneurship through self-employment and modest, but significantly positive, for incorporated startups....

  14. Return to nucleate boiling

    International Nuclear Information System (INIS)

    Shumway, R.W.

    1985-01-01

    This paper presents a collection of TMIN (temperature of return to nucleate boiling) correlations, evaluates them under several conditions, and compares them with a wide range of data. Purpose is to obtain the best one for use in a water reactor safety computer simulator known as TRAC-B. Return to nucleate boiling can occur in a reactor accident at either high or low pressure and flow rates. Most of the correlations yield unrealistic results under some conditions. A new correlation is proposed which overcomes many of the deficiencies

  15. Plasma return current discharge

    International Nuclear Information System (INIS)

    Mangano, J.A.; Hsia, J.; Jacob, J.H.; Srivastava, B.N.

    1978-01-01

    A discharge technique based on the use of an electron-beam-induced plasma return current to produce and heat large-volume plasmas is described. The results of discharge studies using this technique in attachment-dominated mixtures are presented. The results are found to be adequately described by a simple theory. The electron attachment rate by F 2 inferred from these measurements agrees well with those of other workers. KrF laser action at 248 nm is reported in return-current discharge-excited mixtures of F 2 /Kr/He

  16. To return permanently or to return temporarily?: Explaining migrants' intentions

    NARCIS (Netherlands)

    Bilgili, Ö.; Siegel, M.

    2014-01-01

    This paper studies migrants' intentions to return to their origin country by making the distinction between permanent return, temporary return and participation in temporary return programmes. Using survey data from first generation migrants in the Netherlands, we explore how migrants' experiences

  17. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  18. Return to Play

    Science.gov (United States)

    Mangan, Marianne

    2013-01-01

    Call it physical activity, call it games, or call it play. Whatever its name, it's a place we all need to return to. In the physical education, recreation, and dance professions, we need to redesign programs to address the need for and want of play that is inherent in all of us.

  19. Higher Education Endowments Return

    Science.gov (United States)

    Bahlmann, David; Walda, John D.; Sedlacek, Verne O.

    2012-01-01

    A new study of endowments by the National Association of College and University Business Officers (NACUBO) and the Commonfund Institute has brought good news to college and universities: While endowment returns dropped precipitously in fiscal year 2009 as a result of the financial crisis and accompanying slide in equity markets, they climbed to an…

  20. Return telephone and telegraph

    International Nuclear Information System (INIS)

    1976-12-01

    This consists of eleven chapters, which are introduction on return of telephone, modulator and demodulator, transport mode like PCM, wave power for transportation, amplifier for transportation such as transistor, impedance, input-output circuit and voice telephone amplifier, circuit for transportation of telephone, line terminal equipment, standard for transportation, various telephone transport, basic telegraph transport and problems on circuit of transport of telephone.

  1. Return of qualified Sudanese

    Directory of Open Access Journals (Sweden)

    Lindsay T McMahon

    2007-07-01

    Full Text Available With the signing of the Comprehensive Peace Agreement in January 2005, the new Government of South Sudan began to call for the return of the millions of South Sudanese IDP s and refugees. The International Organization for Migration (IOM has developed a programme to help them do so.

  2. Sustainable Mars Sample Return

    Science.gov (United States)

    Alston, Christie; Hancock, Sean; Laub, Joshua; Perry, Christopher; Ash, Robert

    2011-01-01

    The proposed Mars sample return mission will be completed using natural Martian resources for the majority of its operations. The system uses the following technologies: In-Situ Propellant Production (ISPP), a methane-oxygen propelled Mars Ascent Vehicle (MAV), a carbon dioxide powered hopper, and a hydrogen fueled balloon system (large balloons and small weather balloons). The ISPP system will produce the hydrogen, methane, and oxygen using a Sabatier reactor. a water electrolysis cell, water extracted from the Martian surface, and carbon dioxide extracted from the Martian atmosphere. Indigenous hydrogen will fuel the balloon systems and locally-derived methane and oxygen will fuel the MAV for the return of a 50 kg sample to Earth. The ISPP system will have a production cycle of 800 days and the estimated overall mission length is 1355 days from Earth departure to return to low Earth orbit. Combining these advanced technologies will enable the proposed sample return mission to be executed with reduced initial launch mass and thus be more cost efficient. The successful completion of this mission will serve as the next step in the advancement of Mars exploration technology.

  3. Test Your Stroke Knowledge

    Science.gov (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  4. Heart and Stroke Encyclopedia

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  5. Stroke Connection Magazine

    Science.gov (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  6. Stroke (For Kids)

    Science.gov (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  7. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  8. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  9. Hemorrhagic Stroke in Children

    OpenAIRE

    Jordan M.D., Lori C.; Hillis M.D., Argye E.

    2007-01-01

    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  10. Product return management

    DEFF Research Database (Denmark)

    Shaharudin, Mohd Rizaimy; Govindan, Kannan; Zailani, Suhaiza

    2017-01-01

    The aim of this study is to examine the extent to which product returns motivate manufacturing firms to adopt closed-loop supply chain activities that influence the effectiveness of reverse supply chains. The hypotheses have been tested using data from a sample of 150 environmental management...... system ISO 14001 certified manufacturing firms in Malaysia through the census sampling approach. The results of the empirical test using LISREL Version 8.70 for the structural equation modeling support the fundamental explanation of the influence of the institutional forces towards the adoption of closed......-loop supply chain activities and the effectiveness that can be reaped by the manufacturing firms from their adoption. These findings extend the prior research through the verification from the empirical survey on the importance of product returns in the adoption of closed-loop supply chain activities, which...

  11. Systemic Risk and Returns

    OpenAIRE

    Boman, Arthur Lee

    2013-01-01

    I solve a consumption based model, with interfirm systemic risk, for a portfolio optimization with arbitrary return distributions and endogenous stochastic discount factor (sdf). The model highlights a new systemic risk: systemic allocation risk. In contrast to the case without systemic risk, the market and planner allocate capital differently. The externality causes the planner to reduce investment in the risky firm. The market, modeled as a representative agent, does not just ignore the ext...

  12. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  13. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  14. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  15. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  16. Older people's attitudes towards resuming driving in the first four months post-stroke.

    Science.gov (United States)

    McNamara, Annabel; George, Stacey; Ratcliffe, Julie; Walker, Ruth

    2015-03-01

    Little is known about how older people recovering from stroke perceive their return to driving, particularly in the early stages of recovery when they may receive driving information. Semistructured interviews were conducted with 21 participants (52% female, mean age 74.5 years) within the first 16 weeks post-stroke, while inpatients in either acute or rehabilitation stroke wards. Interview data were analysed using content analysis. Three main themes emerged: 'driving as independence', 'emphasis on physical recovery', and 'limits on driving pre-stroke'. For the most part, driving was not a key consideration for participants during this phase of their recovery. Physical restrictions and confidence were seen as the main deterrent to driving post-stroke; however, this varied according to gender. Driving information is generally not retained in the first four weeks of recovery post-stroke. This has implications for the content and timing of driving information given post-stroke. © 2014 ACOTA.

  17. The 'successful' return

    DEFF Research Database (Denmark)

    Olwig, Karen Fog

    2012-01-01

    Research on female migrant caregivers has tended to focus upon the emotional and social problems they encounter working abroad, given women’s traditional role as caregivers for their own families. This article analyses how Caribbean women who have returned after a period abroad as domestic workers...... inscribe their migration experiences within the gendered narrative of the good relative who migrates to help the family left behind and therefore deserves social recognition in the community of origin. It argues that this narrative allows the women to both affirm and reinterpret local family and gender...

  18. Why Returning to VET?

    Directory of Open Access Journals (Sweden)

    Erika Edith Gericke

    2017-11-01

    Full Text Available Educational choices, especially the influence of class on these choices have been a subject of lively international debate. However, thus far, there has been little international and comparative research with respect to vocational and education training (VET decision making from a subject-oriented perspective. This paper considers occupational-biographical orientations of English and German car mechatronics and focuses on the roles of learning and gaining vocational qualifications. Drawing on the concept of occupational-biographical orientations, the paper describes three types of orientations based on analyses of findings from 11 autobiographical-narrative interviews with English and German car mechatronics. The interviews clearly showed that occupational-biographical orientations explained different views on the necessity of returning to (continuous vocational education and training. They also demonstrated that subjective perceptions of the national VET system fostered particular occupational-biographical challenges, which supported or hindered existing learning attitudes. Overall, the findings suggested that occupational-biographical orientations exerted the most important influence on learning biographies and decisions to return to (continuous VET.

  19. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  20. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  1. Sequential strokes in a hyperacute stroke unit.

    Science.gov (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard

    2014-08-01

    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

  2. The Return to Foreign Aid

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan Lars; Hansen, Henrik

    2017-01-01

    We estimate the average rate of return on investments financed by aid and by domestic resource mobilisation, using aggregate data. Both returns are expected to vary across countries and time. Consequently we develop a correlated random coefficients model to estimate the average returns. Across...... different estimators and two different data sources for GDP and investment our findings are remarkably robust; the average gross return on ‘aid investments’ is about 20 per cent. This is in accord with micro estimates of the economic rate of return on aid projects and with aggregate estimates of the rate...

  3. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  4. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

  5. European Stroke Science Workshop

    Science.gov (United States)

    Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick

    2012-01-01

    The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350

  6. Return to space

    Science.gov (United States)

    1989-08-01

    This video documents the preparations for Shuttle Flight STS-26 with Shuttle Discovery, NASA's return to manned space flight after the Challenger disaster. Footage and descriptions document such changes to the new Shuttle as new joints, improved insulation, and added O-rings to the solid rocket boosters; new safety hardware and procedures such as parachute and sidewire evacuations during liftoff, and new pressure suits; modified landing gear, brakes, and nose wheel steering, as well as a modified landing runway. Also profiled are the 5 member crew of all veteran Shuttle astronauts, the TDRS 3 Satellite to be released from the cargo bay in orbit, and 11 commercial and student experiments to be performed during the mission.

  7. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  8. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  9. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  10. The Importance of Patient Involvement in Stroke Rehabilitation

    Science.gov (United States)

    2016-01-01

    Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health

  11. Current clinical practices in stroke rehabilitation: regional pilot survey.

    Science.gov (United States)

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen

    2008-01-01

    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments.

  12. The return of religion

    Directory of Open Access Journals (Sweden)

    S. Griffioen

    2011-06-01

    Full Text Available Religion is back in Philosophy as a respectable subject. Part 1 first charts what MacIntyre, Taylor and Derrida have meant in this regard. Subsequently, it turns to the Enlightenment to determine what constituted the breakthrough. It is found that even where the Enlightenment gave maximum room to religion i.e. as a civic religion and as “religion of the heart” it still excluded a constitutive relation to a transcendent revelation. Part 2 centres on the religion-faith distinction in reformational philosophy. Similar to the Enlightenment, religion is understood as part of human nature. However, human nature itself is conceived as intrinsically religious and depending for its light on revelation. Secondly, “religion” in this context also encompasses idols and religious substitutes. Thus, it directs attention to shopping malls, football stadiums, health policy, et cetera, as possible contexts of a return of religion. Examples show that this has become a popular approach. However, most of the publications surveyed fail to distinguish between an “analogical” and a “pistically qualified” use of religion, and are open to exaggerations (the shopping mall and football stadiums as temples, etc.. At this junction, the relevance is shown of the religion-faith distinction as well as of Elaine Botha’s theory of metaphors. The epilogue offers an integration of parts one and two.

  13. Competition, Innovation and Increasing Returns

    OpenAIRE

    George B. Richardson

    1996-01-01

    This paper concerns the operation of competition in the presence of a high rate of innovation and increasing returns. Given free competition there is likely to exist, in this case, a tendency towards what may be called ‘dynamic equilibrium’, a tendency, that is to say, for the rate of investment in product development to rise or fall towards the level at which this investment yields only a normal return. Thus, competition, increasing returns and innovation may co-exist.

  14. The return to foreign aid

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan Lars; Hansen, Henrik

    We investigate the marginal productivity of investment across countries. The aim is to estimate the return on investments financed by foreign aid and by domestic resource mobilization, using aggregate data. Both returns are expected to vary across countries and time. Consequently we develop...... a correlated random coefficients model, to estimate the average aggregate return on ‘aid investments’ and ‘domestic investments’. Across different estimators and two different sources for GDP and investment data our findings are remarkably robust; the average gross return on ‘aid investments’ is about 20 per...

  15. Immune interventions in stroke

    Science.gov (United States)

    Fu, Ying; Liu, Qiang; Anrather, Josef

    2016-01-01

    Inflammatory and immune responses in the brain can shape the clinical presentation and outcome of stroke. Approaches for effective management of acute stroke are sparse and many measures for brain protection fail, but our ability to modulate the immune system and modify the disease progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In acute stroke, microglia activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions. PMID:26303850

  16. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  17. National Stroke Association

    Science.gov (United States)

    ... Event Join a Stroke Challenge Team Comeback Trail Tell Your Story Community Presentations Faces of Stroke Volunteer With Us ... in a video presentation. Watch Video ... to feel the right side of her body. Kathryn’s friends performed the FAST exam and soon ...

  18. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.

    1988-01-01

    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  19. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....

  20. Acute ischemic stroke update.

    Science.gov (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey

    2010-05-01

    Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for

  1. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  2. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  3. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  4. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

  5. Cerebrorenal interaction and stroke.

    Science.gov (United States)

    Toyoda, Kazunori

    2013-01-01

    Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis. CKD is prevalent in acute stroke patients; patients with estimated glomerular filtration rate stroke patients and 39% of total intracerebral hemorrhage patients in our institute. Acute and chronic management of stroke are influenced by CKD. Therapeutic effects of several antithrombotic and thrombolytic agents, including recently-developed novel oral anticoagulants, are affected by renal function. Moreover, reduced glomerular filtration rate is independently associated with increased 1- and 10-year mortalities in the end. Stroke also has deep relationships with end-stage kidney disease. Stroke occurs much more commonly in dialysis patients than general population or CKD patients without need for dialysis. The triggers of ischemic and hemorrhagic stroke in patients with end-stage kidney disease include special characteristics unique to dialysis, such as drastic hemodynamic change, dialysate and anticoagulants, and vascular calcification. As cohorts of dialysis patients become older, more hypertensive, and more diabetic than before, stroke become more prevalent and more serious events in dialysis clinics. Now, clinicians should have much interest in the association between CKD and cerebrovascular diseases, so-called the cerebro-renal interaction. Copyright © 2013 S. Karger AG, Basel.

  6. Measuring return to work.

    Science.gov (United States)

    Wasiak, Radoslaw; Young, Amanda E; Roessler, Richard T; McPherson, Kathryn M; van Poppel, Mireille N M; Anema, Johannes R

    2007-12-01

    It is argued that one of the factors limiting the understanding of return to work (RTW) following work disability is the use of measurement tools that do not capture a complete picture of workers' RTW experiences. To facilitate the investigation of RTW, the current authors proposed a developmental conceptualization of RTW, which argues for an expanded awareness that encompasses four phases: off work, work reintegration, work maintenance and advancement. This paper reports on work undertaken with the aim of operationalizing the conceptualization. A review of the RTW and related literature, with databases searched including PubMed, EconLit, and PsycInfo. We began by extracting details of RTW instruments used by previous researchers. We then interpreted these within the context of the phases of RTW. Using the International Classification of Functioning, Disability, and Health (ICF) to inform our thinking and coding structure, we conceptualized phase-based RTW outcomes and categorized them as 'tasks and actions', 'contextual' or 'process driven'. Iteratively, we reviewed existing instruments for their use as measures of RTW. Where gaps in instrumentation were found, the wider vocational and career assessment literature was searched for instruments that could be adapted for use in RTW research. Results indicate that, although numerous research instruments have been used to assess RTW, within the scientific literature some important dimensions of RTW lack instrumentation. In particular, we found that outcomes such as goal setting, motivation, expectation, job seeking, work maintenance, and career advancement require operationalization. Amongst the outcomes had been operationalized, we found considerable variation in conceptual development and application. The lack of consistency and comprehensiveness of RTW measurement is one of the factors compromising the advancement of the field of RTW research. It is suggested that a more complete and psychometrically sound array of

  7. A unified engineering model of the first stroke in downward negative lightning

    Science.gov (United States)

    Nag, Amitabh; Rakov, Vladimir A.

    2016-03-01

    Each stroke in a negative cloud-to-ground lightning flash is composed of downward leader and upward return stroke processes, which are usually modeled individually. The first stroke leader is stepped and starts with preliminary breakdown (PB) which is often viewed as a separate process. We present the first unified engineering model for computing the electric field produced by a sequence of PB, stepped leader, and return stroke processes, serving to transport negative charge to ground. We assume that a negatively charged channel extends downward in a stepped fashion during both the PB and leader stages. Each step involves a current wave that propagates upward along the newly formed channel section. Once the leader attaches to ground, an upward propagating return stroke neutralizes the charge deposited along the channel. Model-predicted electric fields are in reasonably good agreement with simultaneous measurements at both near (hundreds of meters, electrostatic field component is dominant) and far (tens of kilometers, radiation field component is dominant) distances from the lightning channel. Relations between the features of computed electric field waveforms and model input parameters are examined. It appears that peak currents associated with PB pulses are similar to return stroke peak currents, and the observed variation of electric radiation field peaks produced by leader steps at different heights above ground is influenced by the ground corona space charge.

  8. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.

    2016-01-01

    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  9. Sexual function in post-stroke patients: considerations for rehabilitation.

    Science.gov (United States)

    Rosenbaum, Talli; Vadas, Dor; Kalichman, Leonid

    2014-01-01

    While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. We report the results of the literature review. Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team. © 2013 International Society for Sexual Medicine.

  10. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  11. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  13. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina

    2013-02-01

    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  14. The Migraine?Stroke Connection

    OpenAIRE

    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang

    2016-01-01

    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like head...

  15. Stroke - risk factors

    Science.gov (United States)

    ... Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of getting ... disease or condition. This article discusses the risk factors for stroke and things you can do to ...

  16. Post-Stroke Rehabilitation

    Science.gov (United States)

    ... negotiate the provision of reasonable accommodations in the workplace. When can a stroke patient begin rehabilitation? Rehabilitation ... at home gives people the advantage of practicing skills and developing compensatory strategies in the context of ...

  17. A Stroke of Language

    Science.gov (United States)

    Blaisdell, Bob

    2011-01-01

    The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.

  18. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  19. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  20. 12 CFR 210.12 - Return of cash items and handling of returned checks.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Return of cash items and handling of returned... cash items and handling of returned checks. (a) Return of items—(1) Return of cash items handled by... shorter return time. (2) Return of checks not handled by Reserve Banks. A paying bank that receives a...

  1. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

    Directory of Open Access Journals (Sweden)

    Chao-jin-zi Li

    2016-01-01

    Full Text Available Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6% was the primary stroke type found in the young group, while ischemic stroke (60.0% was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

  2. Telestroke in stroke survivors.

    Science.gov (United States)

    Joubert, Jacques; Joubert, Lynette B; de Bustos, Elizabeth Medeiros; Ware, Dallas; Jackson, David; Harrison, Terrence; Cadilhac, Dominique

    2009-01-01

    Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices. (c) 2009 S. Karger AG, Basel.

  3. Autopsy approach to stroke.

    Science.gov (United States)

    Love, Seth

    2011-02-01

    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  4. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO

    2016-11-01

    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  5. Total anomalous pulmonary venous return

    Science.gov (United States)

    ... pulmonary venous return, x-ray References Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, ... 62. Review Date 10/17/2017 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, ...

  6. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  7. Improving public education about stroke.

    Science.gov (United States)

    Alberts, Mark J

    2012-09-01

    Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.

  8. How to Organise Return Handling

    OpenAIRE

    de Koster, M.B.M.; van de Vendel, M.; de Brito, M.P.

    2001-01-01

    textabstractAlready for a long time retailers take back products. In this paper we explore the factors contributing to the decision of combining vs. separating inbound and outbound flows during the return handling process. We do so through a comparative analysis of the operations in nine retailer warehouses, which can be divided in three groups: food retailers, department stores and mail order companies. We identify both aggravating factors and facilitating actions for return handling. Furthe...

  9. Relearning the Basics: Rehabilitation after a Stroke

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  10. Mini-Stroke vs. Regular Stroke: What's the Difference?

    Science.gov (United States)

    ... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...

  11. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  12. Stroke risk perception among participants of a stroke awareness campaign

    OpenAIRE

    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

    2007-01-01

    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  13. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  14. World Stroke Organization Global Stroke Services Guidelines and Action Plan

    OpenAIRE

    Lindsay, Patrice; Furie, Karen L.; Davis, Stephen M.; Donnan, Geoffrey A.; Norrving, Bo

    2014-01-01

    Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention,...

  15. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2011-01-01

    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  16. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring

  17. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  18. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    . Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups......BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear. AIMS: The study aims to investigate the association in stroke patients between body mass index...... and risk of death and readmission for recurrent stroke. METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326...

  19. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press

    2015-11-01

    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  20. Sealed Planetary Return Canister (SPRC), Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Sample return missions have primary importance in future planetary missions. A basic requirement is that samples be returned in pristine, uncontaminated condition,...

  1. Sealed Planetary Return Canister (SPRC), Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Sample return missions have primary importance in future planetary missions. A basic requirement is that samples be returned in pristine, uncontaminated condition,...

  2. ACUTE STROKE: FUNCTIONAL OUTCOME PREDICTORS

    OpenAIRE

    Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu

    2016-01-01

    BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...

  3. Abnormal Returns and Contrarian Strategies

    Directory of Open Access Journals (Sweden)

    Ivana Dall'Agnol

    2003-12-01

    Full Text Available We test the hypothesis that strategies which are long on portfolios of looser stocks and short on portfolios of winner stocks generate abnormal returns in Brazil. This type of evidence for the US stock market was interpreted by The Bondt and Thaler (1985 as reflecting systematic evaluation mistakes caused by investors overreaction to news related to the firm performance. We found evidence of contrarian strategies profitability for horizons from 3 months to 3 years in a sample of stock returns from BOVESPA and SOMA from 1986 to 2000. The strategies are more profitable for shorter horizons. Therefore, there was no trace of the momentum effect found by Jagadeesh and Titman (1993 for the same horizons with US data. There are remaing unexplained positive returns for contrarian strategies after accounting for risk, size, and liquidity. We also found that the strategy profitability is reduced after the Real Plan, which suggests that the Brazilian stock market became more efficient after inflation stabilization.

  4. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara

    2015-10-15

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  5. Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke: The EXPLICIT-Stroke Randomized Clinical Trial

    NARCIS (Netherlands)

    Kwakkel, G.; Winters, C.; Wegen, E.E.H. van; Nijland, R.H.; Kuijk, A.A. van; Visser-Meily, A.; Groot, J. de; Vlugt, E. de; Arendzen, J.H.; Geurts, A.C.H.; Meskers, C.G.

    2016-01-01

    Background and Objective Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered

  6. Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early after Stroke : The EXPLICIT-Stroke Randomized Clinical Trial

    NARCIS (Netherlands)

    Kwakkel, Gert; Winters, Caroline; Van Wegen, Erwin E.H.; Nijland, Rinske H.M.; Van Kuijk, Annette A.A.; Visser-Meily, Anne; De Groot, Jurriaan; De Vlugt, Erwin; Arendzen, J. Hans; Geurts, Alexander C.H.; Meskers, Carel G.M.

    2016-01-01

    Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered

  7. Dynamic returns of beta arbitrage

    OpenAIRE

    Nascimento, Mafalda

    2017-01-01

    This thesis studies the patterns of the abnormal returns of the beta strategy. The topic can be helpful for professional investors, who intend to achieve a better performance in their portfolios. Following the methodology of Lou, Polk, & Huang (2016), the COBAR measure is computed in order to determine the levels of beta arbitrage in the market in each point in time. It is argued that beta arbitrage activity can have impact on the returns of the beta strategy. In fact, it is demonstrated that...

  8. Sovereign Risk and Currency Returns

    DEFF Research Database (Denmark)

    Della Corte, Pasquale; Sarno, Lucio; Schmeling, Maik

    We empirically investigate the relation between sovereign risk and exchange rates for a broad set of currencies. An increase in the credit default swap (CDS) spread of a country is accompanied by a significant depreciation of the exchange rate. More generally, CDS spread changes have substantial...... explanatory power for currency returns which is largely driven by shocks to global credit risk. Consistent with the notion that sovereign risk is priced, we find that a country's exposure to global credit risk forecasts excess returns to trading exchange rates as well as to trading on the volatility, skewness...

  9. Sovereign Risk and Currently Returns

    DEFF Research Database (Denmark)

    Della Corte, Pasquale; Sarno, Lucio; Schmeling, Maik

    We empirically investigate the relation between sovereign risk and exchange rates for a broad set of currencies. An increase in the credit default swap (CDS) spread of a country is accompanied by a significant depreciation of the exchange rate. More generally, CDS spread changes have substantial...... explanatory power for currency returns which is largely driven by shocks to global credit risk. Consistent with the notion that sovereign risk is priced, we find that a country's exposure to global credit risk forecasts excess returns to trading exchange rates as well as to trading on the volatility, skewness...

  10. Personal accounts of stroke experiences

    NARCIS (Netherlands)

    Wachters-Kaufmann, CSM

    2000-01-01

    As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics

  11. Questions and Answers about Stroke

    Science.gov (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  12. Stroke and Episodic Memory Disorders

    Science.gov (United States)

    Lim, Chun; Alexander, Michael P.

    2009-01-01

    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  13. Stroke prevention: an update.

    Science.gov (United States)

    Bousser, Marie-Germaine

    2012-03-01

    Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.

  14. Ischemic Stroke and Cancer: Stroke Severely Impacts Cancer Patients, While Cancer Increases the Number of Strokes

    OpenAIRE

    Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho

    2011-01-01

    Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...

  15. Post-stroke psychosis: how long should we treat?

    Directory of Open Access Journals (Sweden)

    Maria do Céu Ferreira

    2017-06-01

    Full Text Available Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone. At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

  16. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  17. Return current instability in flares.

    Science.gov (United States)

    Cromwell, D.; McQuillan, P.; Brown, J. C.

    The authors consider the problem of ion-acoustic wave generation, and resultant anomalous Joule heating, by a return current driven unstable by a small-area thick-target electron beam in solar flares. They find that, contrary to the usual assumption, the hard X-ray bremsstrahlung emission may actually be enhanced in comparison to conventional thick-target models.

  18. Comet coma sample return instrument

    Science.gov (United States)

    Albee, A. L.; Brownlee, Don E.; Burnett, Donald S.; Tsou, Peter; Uesugi, K. T.

    1994-01-01

    The sample collection technology and instrument concept for the Sample of Comet Coma Earth Return Mission (SOCCER) are described. The scientific goals of this Flyby Sample Return are to return to coma dust and volatile samples from a known comet source, which will permit accurate elemental and isotopic measurements for thousands of individual solid particles and volatiles, detailed analysis of the dust structure, morphology, and mineralogy of the intact samples, and identification of the biogenic elements or compounds in the solid and volatile samples. Having these intact samples, morphologic, petrographic, and phase structural features can be determined. Information on dust particle size, shape, and density can be ascertained by analyzing penetration holes and tracks in the capture medium. Time and spatial data of dust capture will provide understanding of the flux dynamics of the coma and the jets. Additional information will include the identification of cosmic ray tracks in the cometary grains, which can provide a particle's process history and perhaps even the age of the comet. The measurements will be made with the same equipment used for studying micrometeorites for decades past; hence, the results can be directly compared without extrapolation or modification. The data will provide a powerful and direct technique for comparing the cometary samples with all known types of meteorites and interplanetary dust. This sample collection system will provide the first sample return from a specifically identified primitive body and will allow, for the first time, a direct method of matching meteoritic materials captured on Earth with known parent bodies.

  19. How to Organise Return Handling

    NARCIS (Netherlands)

    M.B.M. de Koster (René); M. van de Vendel; M.P. de Brito (Marisa)

    2001-01-01

    textabstractAlready for a long time retailers take back products. In this paper we explore the factors contributing to the decision of combining vs. separating inbound and outbound flows during the return handling process. We do so through a comparative analysis of the operations in nine retailer

  20. Phobos Sample Return: Next Approach

    Science.gov (United States)

    Zelenyi, Lev; Martynov, Maxim; Zakharov, Alexander; Korablev, Oleg; Ivanov, Alexey; Karabadzak, George

    The Martian moons still remain a mystery after numerous studies by Mars orbiting spacecraft. Their study cover three major topics related to (1) Solar system in general (formation and evolution, origin of planetary satellites, origin and evolution of life); (2) small bodies (captured asteroid, or remnants of Mars formation, or reaccreted Mars ejecta); (3) Mars (formation and evolution of Mars; Mars ejecta at the satellites). As reviewed by Galimov [2010] most of the above questions require the sample return from the Martian moon, while some (e.g. the characterization of the organic matter) could be also answered by in situ experiments. There is the possibility to obtain the sample of Mars material by sampling Phobos: following to Chappaz et al. [2012] a 200-g sample could contain 10-7 g of Mars surface material launched during the past 1 mln years, or 5*10-5 g of Mars material launched during the past 10 mln years, or 5*1010 individual particles from Mars, quantities suitable for accurate laboratory analyses. The studies of Phobos have been of high priority in the Russian program on planetary research for many years. Phobos-88 mission consisted of two spacecraft (Phobos-1, Phobos-2) and aimed the approach to Phobos at 50 m and remote studies, and also the release of small landers (long-living stations DAS). This mission implemented the program incompletely. It was returned information about the Martian environment and atmosphere. The next profect Phobos Sample Return (Phobos-Grunt) initially planned in early 2000 has been delayed several times owing to budget difficulties; the spacecraft failed to leave NEO in 2011. The recovery of the science goals of this mission and the delivery of the samples of Phobos to Earth remain of highest priority for Russian scientific community. The next Phobos SR mission named Boomerang was postponed following the ExoMars cooperation, but is considered the next in the line of planetary exploration, suitable for launch around 2022. A

  1. Uncertain Educational Returns in a Developing Economy

    Science.gov (United States)

    Mohapatra, Sandeep; Luckert, Martin K.

    2012-01-01

    This paper estimates the distribution of educational returns by gender for India. While previous studies focus on mean returns, the variance of educational returns has important implications for policy-making and micro-level decision making with respect to education. If the variance of educational returns is large, it can leave large sections of…

  2. Ageism in stroke rehabilitation studies.

    Science.gov (United States)

    Gaynor, Eva Joan; Geoghegan, Sheena Elizabeth; O'Neill, Desmond

    2014-05-01

    stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies. all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded. of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes. we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.

  3. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  4. Ischemic strokes and migraine

    International Nuclear Information System (INIS)

    Bousser, M.G.; Baron, J.C.; Chiras, J.

    1985-01-01

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG)

  5. Stroke while jogging.

    OpenAIRE

    Kelly, W. F.; Roussak, J.

    1980-01-01

    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging.

  6. Stroke while jogging.

    Science.gov (United States)

    Kelly, W. F.; Roussak, J.

    1980-01-01

    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging. Images p229-a Fig. 1 PMID:7448490

  7. Sex differences in stroke.

    NARCIS (Netherlands)

    Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.

    2012-01-01

    Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in

  8. Thrombolysis in Postoperative Stroke.

    Science.gov (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan

    2017-11-01

    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  9. Imaging of Hemorrhagic Stroke.

    Science.gov (United States)

    Hakimi, Ryan; Garg, Ankur

    2016-10-01

    Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.

  10. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond

    2006-06-01

    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  11. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery

    Directory of Open Access Journals (Sweden)

    Samar M Hatem

    2016-09-01

    Full Text Available Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed.At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

  12. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

    Science.gov (United States)

    Hatem, Samar M.; Saussez, Geoffroy; della Faille, Margaux; Prist, Vincent; Zhang, Xue; Dispa, Delphine; Bleyenheuft, Yannick

    2016-01-01

    Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation. PMID:27679565

  13. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Secular trends in ischemic stroke subtypes and stroke risk factors.

    Science.gov (United States)

    Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David

    2014-11-01

    Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.

  15. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  16. Understanding Stroke - Know Stroke • Know the Signs • Act in Time

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section Understanding Stroke Know Stroke • Know the Signs • Act in Time Past Issues / ... Julie Harris, and motivational speaker David Layton. Preventing Stroke "Until I had my stroke, I didn't ...

  17. Community re-integration and long-term need in the first five years after stroke: results from a national survey.

    Science.gov (United States)

    Walsh, Mary Elizabeth; Galvin, Rose; Loughnane, Cliona; Macey, Chris; Horgan, N Frances

    2015-01-01

    Acute stroke care continues to improve but the later stroke recovery phase remains less well understood. The aim of this study was to document self-reported need in relation to stroke recovery and community re-integration among community-dwelling persons up to five years post-stroke. A national survey was carried out in Ireland. Participants were recruited through stroke advocacy organisations and health professionals. Existing validated questionnaires were adapted with permission. The final questionnaire assessed respondents' perceptions of their community re-integration and on-going needs. A total of 196 stroke survivors, aged 24-89 years responded. Over 75% of respondents reported experiencing mobility, emotional, fatigue and concentration difficulties post-stroke. Emotional problems and fatigue demonstrated the highest levels of unmet need. Families provided much support with 52% of people needing help with personal care post-stroke. Forty-two per cent of respondents in a relationship felt that it was significantly affected by their stroke. In addition, 60% of respondents reported negative financial change. Only 23% of those <66 years had worked since their stroke, while 60% of drivers returned to driving. Stroke had a personal, social and economic impact. Emotional distress and fatigue were common and satisfaction with the help available for these problems was poor. Implications for Rehabilitation Professionals should recognise that family members provide high levels of support post-stroke while dealing with changes to personal relationships. Emotional, concentration and fatigue problems post-stroke require recognition by health professionals. A greater focus on return-to-work as part of stroke rehabilitation may be of value for patients of working age.

  18. American College of Sports Medicine Roundtable on Exertional Heat Stroke - Return to Duty/Return to Play: Conference Proceedings

    Science.gov (United States)

    2010-01-01

    dysfunctions likely include blood brain barrier breakdown, blood-cerebral spinal fluid barrier break- down, serum protein leakage, and exacerbated drug ...nonsteroidal antiinflammatory drugs (NSAID), to compromise hypothalamic and liver function, exac- erbate tissue injury, and/or impede tissue recovery must be...factors for EHS include age 940 yr, med- ications (anticholinergics, antihistamines , stimulants to include medication for attention deficit

  19. Philopatry: A return to origins

    Science.gov (United States)

    Pearce, John M.

    2007-01-01

    The word “philopatry” is a combination of the prefix philo (from the Greekphilos, “beloved”) and the Latin patria, which means “fatherland” or “homeland.” Since the first English-language use of “philopatry” in an ornithological context by Huntington (1951), the term has been applied to two types of site-faithful behavior in birds. Closest to the etymological meaning is the first, “natal philopatry,” which means not dispersing far from, or returning to, a birthplace for reproduction. The second is “breeding philopatry,” which means returning to the same breeding area each year, though that area may not be an individual’s birth place (Shields 1982, Anderson et al. 1992). Therefore, any assessment of breeding philopatry likely includes some immigrant individuals, whereas assessments of natal philopatry include only locally hatched or born individuals.

  20. Returns to Education across Europe

    OpenAIRE

    Glocker, Daniela; Steiner, Viktor

    2011-01-01

    Incentives to invest in higher education are affected by both the direct wage effect of human capital investments and the indirect wage effect resulting from lower unemployment risks and shorter spells in unemployment associated with higher educated. We analyse the returns to education in Austria, Germany, Italy, Sweden and the United Kingdom, countries which differ significantly regarding both their education systems and labour market structure. We estimate augmented Mincerian wage equations...

  1. Financial Integration and Asset Returns

    OpenAIRE

    P Martin; H Rey

    2000-01-01

    The paper investigates the impact of financial integration on asset return, risk diversification and breadth of financial markets. We analyse a three-country macroeconomic model in which (i) the number of financial assets is endogenous; (ii) assets are imperfect substitutes; (iii) cross-border asset trade entails some transaction costs; (iv) the investment technology is indivisible. In such an environment, lower transaction costs between two financial markets translate to higher demand for as...

  2. Investment Taxes and Equity Returns

    OpenAIRE

    Clemens Sialm

    2006-01-01

    This paper investigates whether investors are compensated for the tax burden of equity securities. Effective tax rates on equity securities vary due to frequent tax reforms and due to persistent differences in propensities to pay dividends. The paper finds an economically and statistically significant relationship between risk-adjusted stock returns and effective personal tax rates using a new data set covering tax burdens on a cross-section of equity securities between 1927 and 2004. Consist...

  3. The concept of early rehabilitation (fast track in operative gynecology

    Directory of Open Access Journals (Sweden)

    О. S. Lashkul

    2017-04-01

    Full Text Available Introduction. Application of laparoscopic techniques corresponds to the principles of the FTS maximally. Aim – to assess the impact of the early multimodal rehabilitation concept use on the postoperative period. Material and Methods. The study involved 39 patients who were randomized by method of envelopes into two groups. In the basic group (20 patients a multimodal protocol of early rehabilitation was used. In the control group (19 patients a traditional perioperative regimen was performed. In both groups, vaginal hysterectomy with laparoscopic support under general anesthesia combined with mechanical ventilation was carried out. Fentanyl analgesia (5 - 3 mcg / kg / hr and 0.5% bupivacaine solution into epidural space (6.8 mL were given. The volume of the infusion in the main group was 5 - 6 ml / kg / h, in the control group - 10 ml / kg / hr. The perioperative analgesia included NSAIDs (deksetoprofen, ketorolac, paracetamol. Noninvasive monitoring was carried out by monitor "Leon" (blood pressure, heart rate, capnogram, the hourly diuresis was taken into account, and thermometry was done. Postoperatively in both groups 24 hours prolonged epidural analgesia with small boluses of 0.25% bupivacaine solution (4 ml / hour in combination with systemic injection of dexketoprofen (100-150 mg / day + ketorolac (60 mg / day + paracetamol (2000 mg / day was used. Results. The groups were homogeneous by anamnestic (the onset of menstruation, number of pregnancies, childbirths, induced abortions, spontaneous abortions, anthropometric and demographic characteristics, by the duration of operations and the reference levels of systolic, diastolic, mean arterial pressure and heart rate. The volume of blood loss (ml in patients with FTS was (282 ± 22, in patients of the control group - (347±21, p˂0.05. Intraoperative hemohydrobalance (ml in patients with FTS was (547 ± 57, in the control group - (942 ± 62, p˂0.05. The postoperative bed-day index in patients of the main group (FTS was significantly lower (5.00 ± 0.26 than in the control group of patients without FTS (7.16 ± 0.40, p˂0.05. Conclusions. Optimal anesthetic tactic allows patients to be extubated quickly and to eliminate postoperative pain in the first 24 hours effectively. Using the early multimodal rehabilitation protocol reduces the time of patients’ recovery after vaginal hysterectomy with laparoscopic assistance.

  4. LM6000s bring fast track power to Tanzania

    Energy Technology Data Exchange (ETDEWEB)

    Lukas, R. [Stone and Webster Canada Ltd., Toronto, ON (Canada); Sutcliffe, K. [Stewart and Stevenson Services, Houston, TX (United States); Oosthuizen, P. [Roshcon, Johannesburg (South Africa)

    1996-06-01

    Like many developing countries, Tanzania is in urgent need of power. To ease the situation, the Tanzanian government utility, Tanzania Electric Supply Company (Tanesco) recently began operating a power plant using two LM6000 aeroderivative gas turbines at a facility in Ubungo. The plant began operation just 165 days after the order was placed. (author)

  5. Fast-track protocols in devascularization for cirrhotic portal hypertension

    Directory of Open Access Journals (Sweden)

    Yang Fei

    2015-06-01

    Full Text Available Summary Introduction/objective: fast-tract surgery (FTS has been rapidly embraced by surgeons as a mechanism for improving patient care and driving down complications and costs. The aim of this study was to determine if any improvement in outcomes occurred after FTS protocol for selective double portazygous disconnection with preserving vagus (SDPDPV compared with non-FTS postoperative care. Methods: patients eligible for SDPDPV in the period January 2012-April 2014 were randomly selected for the FTS group or non-FTS group. A designed protocol was used in the FTS group with emphasis on an interdisciplinary approach. The non-FTS group was treated using previously established standard procedures. The number of postoperative complications, time of functional recovery and duration of hospital stay were recorded. Results: patients in the FTS group (n=59 and non-FTS group (n=57 did not differ in terms of preoperative data and operative details (p>0.05. The FTS procedure led to significantly better control and faster restoration of gastrointestinal functions, food tolerance, rehabilitation and hospital discharge (p<0.05. Postoperative complications, including nausea/vomiting, severe ascites, wound infection, urinary tract infection and pulmonary infection were all significantly lower in the FTS group (p<0.05. According to the postoperative morbidity classification used by Clavien, overall complications and grade I complications were both significantly lower in the FTS group compared with the non-FTS group (p<0.05. Conclusion: adopting the FTS protocol helped to recover gastrointestinal functions, to reduce frequency of postoperative complications and to reduce hospital stay. The FTS strategy is safe and effective in improving postoperative outcomes.

  6. Fast-track surgery for bilateral total knee replacement

    DEFF Research Database (Denmark)

    Husted, H; Troelsen, A; Otte, K S

    2011-01-01

    Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised...

  7. Study of hardware implementations of fast tracking algorithms

    International Nuclear Information System (INIS)

    Song, Z.; Huang, G.; Wang, D.; Lentdecker, G. De; Dong, J.; Léonard, A.; Robert, F.; Yang, Y.

    2017-01-01

    Real-time track reconstruction at high event rates is a major challenge for future experiments in high energy physics. To perform pattern-recognition and track fitting, artificial retina or Hough transformation methods have been introduced in the field which have to be implemented in FPGA firmware. In this note we report on a case study of a possible FPGA hardware implementation approach of the retina algorithm based on a Floating-Point core. Detailed measurements with this algorithm are investigated. Retina performance and capabilities of the FPGA are discussed along with perspectives for further optimization and applications.

  8. The fast track to L\\"owner's theorem

    OpenAIRE

    Hansen, Frank

    2011-01-01

    The operator monotone functions defined in the positive half-line are of particular importance. We give a version of the theory in which integral representations for these functions can be established directly without invoking L\\"owner's detailed analysis of matrix monotone functions of a fixed order or the theory of analytic functions. We found a canonical relationship between positive and arbitrary operator monotone functions defined in the positive half-line, and this result effectively re...

  9. Perioperative factors affecting fast tracking in paediatrics cardiac ...

    African Journals Online (AJOL)

    Young age was found to be a factor associated with prolonged mechanical ventilation and extubation. Further, the presence of pulmonary hypertension, lower cardiac grade and ventricular dysfunction were found to be factors significantly associated with prolonged weaning. While, cardiac disease occurring in combination, ...

  10. Fast track developments, Gulf of Mexico -- options and organization

    International Nuclear Information System (INIS)

    Craig, M.J.K.; Carruth, R.E.

    1995-01-01

    The pressure continues to compress the 'idea to barrel' time period -- to get oil and gas from a discovery into the pipeline as quickly, cheaply and safely as possible. This paper discusses the range of development options presently available in the Gulf of Mexico (GoM) to meet these goals, and a project organizational structure that allows for maximum implementation efficiency. The structural options range from a standard 4-pile to a single, freestanding caisson, and the spectrum of 'minimum structures' in between. Developments in water depths of 100 feet and 200 feet are addressed, as are each system's associated costs, relative risks and startup times. Project organization is also addressed in terms of an effective in-house and out-of-house project organizational structure, the necessary attributes of the key members of this organization, and the most effective types of contracting

  11. A Landscape of Opportunities: Fast Tracking Down Under

    OpenAIRE

    Jain, Lorna

    2009-01-01

    Reflexivity is important to nursing as it allows opportunity to reflect on how knowledge, both formal and tacit, and understanding have been developed within the context of the nurse’s own perspectives (Freshwater 2002; Johns & Freshwater 2005). When embarking on my nursing career I was encouraged to keep a diary of my journey so that I would be able to look back and make sense of multifaceted learning experiences I would encounter along the way. Keeping a diary was particularly pertinent as,...

  12. Perioperative Factors Affecting Fast Tracking in Paediatrics Cardiac ...

    African Journals Online (AJOL)

    jen

    East and Central African Journal of Surgery - Volume 14 Number 2 – July/August 2009. 38. Perioperative ... the presence of pulmonary hypertension, lower cardiac grade and ventricular dysfunction were found to be ... Patients with left ventricular hypertrophy are susceptible to diastolic dysfunction; diastolic dysfunction ...

  13. Delirium in the fast-track surgery setting

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, Lars S; Kehlet, Henrik

    2012-01-01

    Postoperative delirium (PD) and postoperative cognitive dysfunction (POCD) are two separate syndromes of cognitive decline after major surgery, especially in the elderly. Pathogenesis is multifactorial with some common risk factors, and to reduce the risk, a multimodal approach is necessary...

  14. Following a fast track course for refugee teachers

    NARCIS (Netherlands)

    Maaike Hajer; Catarina Economou

    2017-01-01

    The aim of this small explorative study was to get an impression of the participants’ views and understanding of the role of becoming a teacher in Swedish schools, realising the characteristic of pedagogy aimed for in the curriculum (in Lgr11 and Lgy), specifically the interaction patterns and

  15. Tick size and stock returns

    Science.gov (United States)

    Onnela, Jukka-Pekka; Töyli, Juuso; Kaski, Kimmo

    2009-02-01

    Tick size is an important aspect of the micro-structural level organization of financial markets. It is the smallest institutionally allowed price increment, has a direct bearing on the bid-ask spread, influences the strategy of trading order placement in electronic markets, affects the price formation mechanism, and appears to be related to the long-term memory of volatility clustering. In this paper we investigate the impact of tick size on stock returns. We start with a simple simulation to demonstrate how continuous returns become distorted after confining the price to a discrete grid governed by the tick size. We then move on to a novel experimental set-up that combines decimalization pilot programs and cross-listed stocks in New York and Toronto. This allows us to observe a set of stocks traded simultaneously under two different ticks while holding all security-specific characteristics fixed. We then study the normality of the return distributions and carry out fits to the chosen distribution models. Our empirical findings are somewhat mixed and in some cases appear to challenge the simulation results.

  16. Challenging comparison of stroke scales

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2013-01-01

    Full Text Available Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS and Barthel index (BI are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.

  17. Post-stroke urinary incontinence.

    Science.gov (United States)

    Mehdi, Z; Birns, J; Bhalla, A

    2013-11-01

    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  18. Perceived wellbeing of patients one year post stroke in general practice - recommendations for quality aftercare

    NARCIS (Netherlands)

    de Weerd, Leonie; Rutgers, Wijnand A. F.; Groenier, Klaas H.; van der Meer, Klaas

    2011-01-01

    Background: Annually, 41,000 people in the Netherlands have strokes. This has multiple physical and psychosocial consequences. Most patients return home after discharge from hospital. Quality aftercare by general practitioners is important to support patients at home. The purpose of this study is to

  19. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  20. For whom the desert bell tolls: heat stroke or stroke

    Directory of Open Access Journals (Sweden)

    Mustafa Bolatkale

    2017-06-01

    Full Text Available Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.

  1. British Association of Stroke Physicians: benchmarking survey of stroke services.

    Science.gov (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony

    2003-03-01

    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  2. Explaining Returns with Cash-Flow Proxies

    OpenAIRE

    Peter Hecht; Tuomo Vuolteenaho

    2005-01-01

    Stock returns are correlated with contemporaneous earnings growth, dividend growth, future real activity, and other cash-flow proxies. The correlation between cash-flow proxies and stock returns may arise from association of cash-flow proxies with one-period expected returns, cash-flow news, and/or expected-return news. We use Campbell's (1991) return decomposition to measure the relative importance of these three effects in regressions of returns on cash-flow proxies. In some of the popular ...

  3. Hemichorea after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sadullah Saglam

    2016-03-01

    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  4. [Smoking and stroke].

    Science.gov (United States)

    Hashimoto, Yoichiro

    2011-05-01

    Cigarette smoking is a risk factor for the brain infarction (lacunar and atherothrombotic brain infarction) and subarachnoid hemorrhage. Not only active smoking but also passive smoking and smokeless tobacco products pose a risk. The risk after smoking cessation for 5-10 years is equal to that faced by a non-smoker. Many patients continue smoking even after an attack of stroke; therefore, support measures to enforce nonsmoking are required in this high-risk population. We offer nonsmoking support using the 5A approach, and assess the nonsmoking stage (precontemplation, contemplation, preparation, action, and maintenance). We also administer medical therapy for smoking cessation when the patients find it difficult to quit smoking on their own accord. Nicotine dependency needs a follow-up like that required for other risk factors in the primary and secondary prevention of the stroke because smoking is a chronic disease that tends to recur.

  5. Detrusor Hyperreflexia in Stroke

    OpenAIRE

    AYBEK, Zafer

    2014-01-01

    In this study detrusor hyperreflexia was investigated by urodynamic study during the acute phase of stroke in patients who became incontinent after a cerebrovascular accident. Urodynamic studies reveal physiopathological findings of incontinence while the acute period of cerebrovascular accident do not cover neurogenic bladder features. In our study it was observed that most of the patients (60%) had normal bladder functions and detrusor hyperreflexia was a rare rindings. This res...

  6. Stroke Management: Nursing Roles

    OpenAIRE

    Maryam Esmaeili

    2017-01-01

    Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms. Methods: This is a review paper that report up to date finding with review some...

  7. Early rehabilitation after stroke.

    Science.gov (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter

    2017-02-01

    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  8. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  9. Acute Stroke Imaging Research Roadmap

    OpenAIRE

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.

    2008-01-01

    The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced n...

  10. Problematising risk in stroke rehabilitation.

    Science.gov (United States)

    Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula

    2016-11-01

    Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or

  11. Guide to Choosing Stroke Rehabilitation Services

    Science.gov (United States)

    National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you:  Re-learn basic skills such ...

  12. What You Need to Know about Stroke

    Science.gov (United States)

    ... the brain. The other kind of stroke, called hemorrhagic stroke, is caused by a blood vessel that breaks ... are very common among African Americans. The best treatment for stroke is prevention. You can reduce your ...

  13. Epidermoid Causing Ischemic Stroke in the Brainstem

    Directory of Open Access Journals (Sweden)

    Raghvendra Ramdasi

    2014-01-01

    Full Text Available Intracranial tumors may rarely cause stroke. We report an epidermoid cyst causing stroke in a pediatric patient. We have also reviewed the literature and pathogenesis of stroke caused by intracranial tumors.

  14. What Are the Warning Signs of Stroke?

    Science.gov (United States)

    ... Cardiovascular Conditions What Are the Warning Signs of Stroke? Brain tissue affected by blockage Stroke is the fifth leading cause of death in ... over 55 years old have more chance of stroke, and the risk gets greater as you get ...

  15. Burden of stroke in Cambodia.

    Science.gov (United States)

    Loo, Keat Wei; Gan, Siew Hua

    2013-08-01

    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  16. Infections and Ischemic Stroke Outcome

    OpenAIRE

    Grabska, Katarzyna; Gromadzka, Grażyna; Członkowska, Anna

    2011-01-01

    Background. Infections increase the risk of ischemic stroke (IS) and may worsen IS prognosis. Adverse effects of in-hospital infections on stroke outcome were also reported. We aimed to study the prevalence of pre- and poststroke infections and their impact on IS outcome. Methods. We analysed clinical data of 2066 IS patients to assess the effect of pre-stroke and post-stroke infections on IS severity, as well as short-term (up to 30 days) and long-term (90 days) outcome. The independent i...

  17. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

    Ahmed, R.; Zuberi, F.Z.; Afsar, S.

    2004-01-01

    Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

  18. Identification of stroke mimics among clinically diagnosed acute strokes.

    Science.gov (United States)

    Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch

    2013-09-01

    Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since treatment plan may differ To determine the incidence of the stroke mimics and identify their etiologies. All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical follow-up records were reviewed for final diagnosis. Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.40%) were hemorrhagic stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage (14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.30%), central nervous system infection (5, 2.7%), others (26, 14.0%), and unspecified (16, 8.6%). Incidence rates and etiologies of the stroke mimics were similar to the western reports. However the frequency of each mimic was not.

  19. Returning to sports after a back injury

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000518.htm Returning to sports after a back injury To use the sharing ... Back pain - returning to sports Which Type of Sport is Best? In deciding when and if to ...

  20. Returns to Tenure or Seniority?

    DEFF Research Database (Denmark)

    Buhai, Ioan Sebastian; Portela, Miguel; Teulings, Coen

      This study documents two empirical regularities, using data for Denmark and Portugal. First, workers who are hired last, are the first to leave the firm (Last In, First Out; LIFO). Second, workers' wages rise with seniority (= a Worker's tenure relative to the tenure of her colleagues). We seek...... at the moment of separation). The LIFO rule provides a stronger bargaining position for senior workers, leading to a return to seniority in wages. Efficiency in hiring requires the workers' .bargaining power to be in line with their share in the cost of specific investment. Then, the LIFO rule is a way...

  1. Stroke in Saudi children

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Kentab, Anal Y.; Al-Nasser, Mohammad N.; Bahakim, Hassan M.; Kurban, Khadija M.; Zahraa, Jihad N.; Nasir, Ali A.; Abdel-Gader, Abdel-Galil M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.; Kabiraj, Mohammad M.; Khoja, Waleed A.

    2006-01-01

    To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors. The Retrospective Study Group (RSG) included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group (PSG) included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children (61 males and 56 females, aged one month-12 years) were evaluated; the majority (89%) of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric (1month-12 years) population The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months (SD=39.3 months) median and median was 6 months. Ischemic strokes accounted for the majority of cases (76%). Large-vessel infarcts (LVI, 51.9%) were more common than small-vessel lacunar lesions (SVLL, 19.2%). Five patients (4.8%) had combined LVI and SVLL. Intracranial hemorrhage was less common (18.2%), whereas sinovenous thrombosis was diagnosed in 6 (5.8%) patients. A major risk factor was identified in 94 of 104 (89.4%) Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG (p=0.001), reflecting a better yield following introduction of more comprehensive hematologic and cogulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor (46.2%); presumed perinatal ischemic cerebral injury was risk factor in 23 children (22.1) and infectious and inflammatory disorders of the circulatory system in 18 (17.3%). Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients (6.7%) and

  2. Participation in Leisure Activity and Exercise of Chronic Stroke Survivors Using Community-Based Rehabilitation Services in Seongnam City

    Science.gov (United States)

    Yi, Tae Im; Lee, Ko Eun; Ha, Seung A

    2015-01-01

    Objective To clarify how participation in leisure activities and exercise by chronic stroke survivors differs before and after a stroke. Methods Sixty chronic stroke survivors receiving community-based rehabilitation services from a health center in Seongnam City were recruited. They completed a questionnaire survey regarding their demographic characteristics and accompanying diseases, and on the status of their leisure activities and exercise. In addition, their level of function (Korean version of Modified Barthel Index score), risk of depression (Beck Depression Inventory), and quality of life (SF-8) were measured. Results After their stroke, most of the respondents had not returned to their pre-stroke levels of leisure activity participation. The reported number of leisure activities declined from a mean of 3.9 activities before stroke to 1.9 activities post-stroke. In addition, many participants became home-bound, sedentary, and non-social after their stroke. The most common barriers to participation in leisure activities were weakness and poor balance, lack of transportation, and cost. The respondents reported a mean daily time spent on exercise of 2.6±1.3 hours. Pain was the most common barrier to exercise participation. Conclusion Chronic stroke survivors need information on leisure activities and appropriate pain management. PMID:25932420

  3. 7 CFR 356.8 - Return procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 5 2010-01-01 2010-01-01 false Return procedure. 356.8 Section 356.8 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FORFEITURE PROCEDURES § 356.8 Return procedure. If, at the conclusion of proceedings, seized property is to be returned to the...

  4. The Zodiac Calendar and Equity Factor Returns

    NARCIS (Netherlands)

    J. Phoeng (Janice); L.A.P. Swinkels (Laurens)

    2016-01-01

    textabstractWe calculate the returns for four well-known equity factor returns, the market, size, value, and momentum, for each Zodiac calendar year from 1926 to 2015. We find that point estimates of average returns for each Zodiac sign can be substantially different. However, when we employ

  5. Common Factors in International Bond Returns

    NARCIS (Netherlands)

    Driessen, J.J.A.G.; Melenberg, B.; Nijman, T.E.

    2000-01-01

    In this paper we estimate and interpret the factors that jointly determine bond returns of different maturities in the US, Germany and Japan.We analyze both currency-hedged and unhedged bond returns.For currency-hedged bond returns, we find that five factors explain 96.5% of the variation of bond

  6. Foreign currency returns and systematic risks

    NARCIS (Netherlands)

    Galsband, V.; Nitschka, T.

    2015-01-01

    We apply an empirical approximation of the intertemporal capital asset pricing model (ICAPM) to show that cross-sectional dispersion in currency returns can be rationalized by differences in currency excess returns' sensitivities to the market return's cash-flow news component. This finding echoes

  7. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

    ... Clots) (American Stroke Association) Let's Talk about Ischemic Stroke (American Heart Association) Also in Spanish Prevention and Risk Factors Carotid Endarterectomy (National Heart, Lung, and Blood Institute) ...

  8. Stroke subtypes and factors associated with ischemic stroke in ...

    African Journals Online (AJOL)

    Stroke subtypes assessed four OCSP (Oxfordshire Communi-. African Health Sciences Vol 15 Issue 1, March 2015. 68. 69 ty Stroke Project Classification) subtypes classification. 13 was used with lacunar circulation infarct (LACI) and total anterior (TACI), partial anterior (PACI), posterior. (POCI) circulation infarcts as non ...

  9. 'This stroke was sent…': Stroke-related illness concepts and ...

    African Journals Online (AJOL)

    Though there is evidence that stroke incidence is increasing even in low and middle income countries, there is no study of stroke-related illness concepts and HSB in Nigerians. Data from 960 educated Nigerians were analysed. Eight hundred and fifty four respondents (431 aged 20-40 years and 423 aged 41 years or ...

  10. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)

    2002-01-01

    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic

  11. Thromboxane biosynthesis in stroke and post-stroke dementia

    NARCIS (Netherlands)

    F. van Kooten (Fop)

    2002-01-01

    textabstractWith 25 to 30 thousand new patients per year and an incidence of 170/100.000, stroke is a major health problem in the Netherlands, as it is in other western countries. It accounts for almost I 0% of the annual death in the Netherlands. Approximately 80% of stroke is of ischemic origin,

  12. Improving Stroke Management through Specialized Stroke Units in ...

    African Journals Online (AJOL)

    ... rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment ...

  13. Beneficial effects of footbaths in controlling spasticity after stroke

    Science.gov (United States)

    Matsumoto, Shuji; Shimodozono, Megumi; Etoh, Seiji; Shimozono, Yurika; Tanaka, Nobuyuki; Kawahira, Kazumi

    2010-07-01

    Footbaths are considered to provide beneficial thermal therapy for post-stroke patients with spasticity, but their anti-spastic effects have not been investigated comprehensively. The present study aimed to evaluate alterations in motor-neuron excitability using F-wave parameters in post-stroke patients with spastic hemiplegia. Subjects’ legs below the knee joint were immersed in water at 41°C and F-wave recordings were made over the abductor hallucis muscle before, immediately after, and 30 min after thermal treatment. Antidromic stimulation was performed on the tibial nerve at the ankle. Measurements included F-wave amplitude, F-wave/M-response ratio, changes in modified Ashworth scale (MAS), body temperature and surface-skin temperature. The mean values of both F-wave parameters were higher on the affected side before footbath treatment. In post-stroke patients, the mean values of F-wave parameters were significantly reduced after footbath treatment ( P spastic effects of footbath treatment were indicated by decreased F-wave parameters, in parallel with decreases in MAS. Body temperature was significantly increased both immediately after, and 30 min following footbath treatment in both groups, which appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after footbath treatment in both groups and returned to baseline 30 min later. These findings demonstrate that the use of footbaths is an effective nonpharmacological anti-spastic treatment that might facilitate stroke rehabilitation.

  14. Return to sport following amputation.

    Science.gov (United States)

    Matthews, D; Sukeik, M; Haddad, F

    2014-08-01

    Amputation in athletes has a substantial impact on lifestyle and sporting activity, as well as self-perception and quality of life. The impact of limb loss on athletic ability will vary depending on the cause of amputation and the anatomical location of the amputation. The use of sporting activity for rehabilitation of amputees was first introduced in 1944 at Stoke Mandeville Hospital. The first international paralympic games were founded in 1960. Following these events the opportunity to participate in sport following limb loss has increased significantly. Sport participation has been aided by the development of sporting prostheses, however multiple factors will determine the exact prosthesis used. These include the nature of the sporting activity as well as the level of the amputation. The biomechanics involved in walking and running are altered following the loss of a limb or part thereof. This can cause subsequent degenerative changes within the remaining joints on the amputated limb as well as the contralateral limb. Factors affecting return to sporting activity are multivariate and inter-related, including patient factors, surgical factors, nature and level of the sporting activity and prosthetic factors. The authors review current literature, detail predictive factors of return to sport and the physical and psychosocial impact on patients following limb amputation.

  15. Diagnosis in stroke - an uptake

    International Nuclear Information System (INIS)

    Aichner, F.T.

    2003-01-01

    In practical day-to-day terms, most patients have one of the common causes of stroke: ischemic stroke caused by the complications of atherothrombosis, intracranial small vessel disease, embolism from the heart, primary intracerebral hemorrhage caused by hypertension, or subarachnoid hemorrhage as a result of a ruptured saccular aneurysm. There are three issues to be considered in assessing the reliability of the clinical diagnosis of stroke: the diagnosis of stroke itself: is it a stroke or not; whether the stroke is caused by an infarct or a hemorrhage and particular in ischemic stroke the site and size of the lesion (anterior vs. posterior circulation, lacunar vs. cortical, etc.). No clinical scoring method can differentiate with absolute reliability ischemic stroke from primary intracerebral hemorrhage. To do this brain computed tomography or magnetic resonance imaging is required. For vascular diagnosis ultrasound and magnetic resonance angiography are ideal and complementary non-invasive techniques. Both have no risks and are reasonably sensitive. Catheterangiography is only reserved for patients with subarachnoid hemorrhage with a view to surgical or endovascular treatment or in exceptional cases to establish a more firm prognosis. The diagnosis of ischemic stroke caused by embolism from the heart can only be considered at all if there is an identifiable cardioembolic source which is the case in about 30 % of ischemic stroke, a higher proportion in recent studies using transoesophageal echocardiography. It is not clear that transoesophageal echocardiography provides much more information for clinical decision-making than transthoracic echocardiography, although it certainly provides more anatomical information in selected patients. This article summarizes the diagnostic armamentarium which is used for the diagnosis of stroke and gives an overview of clinically reliable and relevant measures. Refs. 23 (author)

  16. Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision

    Science.gov (United States)

    Radford, Kathryn; Grant, Mary; Terry, Jane

    2014-01-01

    Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to

  17. The Role of Citicoline in Neuroprotection and Neurorepair in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Gustavo C. Román

    2013-09-01

    Full Text Available Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair. Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients’ functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation.

  18. Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke

    Directory of Open Access Journals (Sweden)

    Jason W. Siefferman

    2015-01-01

    Full Text Available Brain injury can lead to impaired cortical inhibition of the hypothalamus, resulting in increased sympathetic nervous system activation. Symptoms of paroxysmal sympathetic hyperactivity may include hyperthermia, tachycardia, tachypnea, vasodilation, and hyperhidrosis. We report the case of a 41-year-old man who suffered from a left middle cerebral artery stroke and subsequently developed central fever, contralateral temperature change, and hyperhidrosis. His symptoms abated with low-dose propranolol and then returned upon discontinuation. Restarting propranolol again stopped his symptoms. This represents the first report of propranolol being used for unilateral dysautonomia after stroke. Propranolol is a lipophilic nonselective beta-blocker which easily crosses the blood-brain barrier and may be used to treat paroxysmal sympathetic hyperactivity.

  19. Iterative learning control for electrical stimulation and stroke rehabilitation

    CERN Document Server

    Freeman, Chris T; Burridge, Jane H; Hughes, Ann-Marie; Meadmore, Katie L

    2015-01-01

    Iterative learning control (ILC) has its origins in the control of processes that perform a task repetitively with a view to improving accuracy from trial to trial by using information from previous executions of the task. This brief shows how a classic application of this technique – trajectory following in robots – can be extended to neurological rehabilitation after stroke. Regaining upper limb movement is an important step in a return to independence after stroke, but the prognosis for such recovery has remained poor. Rehabilitation robotics provides the opportunity for repetitive task-oriented movement practice reflecting the importance of such intense practice demonstrated by conventional therapeutic research and motor learning theory. Until now this technique has not allowed feedback from one practice repetition to influence the next, also implicated as an important factor in therapy. The authors demonstrate how ILC can be used to adjust external functional electrical stimulation of patients’ mus...

  20. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature i...

  1. One Stroke at a Time

    Science.gov (United States)

    Hollibaugh, Molly

    2012-01-01

    At first glance, a Zentangle creation can seem intricate and complicated. But, when you learn how it is done, you realize how simple it is. Zentangles are patterns, or "tangles," that have been reduced to a simple sequence of elemental strokes. When you learn to focus on each stroke you find yourself capable of things that you may have once…

  2. The dynamics of health and return migration.

    Directory of Open Access Journals (Sweden)

    Anita A Davies

    2011-06-01

    Full Text Available The increasing importance and complexity of migration globally also implies a global increase in return migration, and thus an increased interest in the health of returning migrants. The health of returning migrants is impacted by the cumulative exposure to social determinants and risk factors of health during the migration process, during the return movement, and following return. Circular migration often occurs among the diaspora, which can result in the transfer of knowledge and skills that contribute to development, including health system strengthening. Migrants with dual nationality often return to countries with better health services than their country of origin when they are sick and can not get care at home. To maintain and improve the health of returning migrants, multi-sectoral policies at global and national levels should facilitate access to appropriate and equitable health services, social services, and continuity of care across and within borders.

  3. Stock return comovement and Korean business groups

    Directory of Open Access Journals (Sweden)

    Chan Ho Cho

    2015-12-01

    Full Text Available This paper explores whether business group affiliations affect the covariance structure of stock returns in Korea. We find that the stock returns of firms belonging to the same business group show positive and significant comovement. The strong comovement between group returns and firm returns is explained by correlated fundamentals. We find strong comovement among business group affiliate earnings. Moreover, variance decomposition of returns shows that cash flow news plays a relatively more important role in explaining group comovement than discount rate news, suggesting a link between stock return comovement and the “tunneling” and “propping” behaviors of business groups. Finally, return comovement increases when a firm joins a business group.

  4. Single-shot observation of growing streamers using an ultrafast camera

    International Nuclear Information System (INIS)

    Takahashi, E; Kato, S; Furutani, H; Sasaki, A; Kishimoto, Y; Takada, K; Matsumura, S; Sasaki, H

    2011-01-01

    A recently developed ultrafast camera that can acquire 10 8 frames per second was used to investigate positive streamer discharge. It enabled single-shot evaluation of streamer evolution without the need to consider shot-to-shot reproducibility. This camera was used to investigate streamers in argon. Growing branches, the transition when a streamer forms a return stroke, and related phenomena were clearly observed. (fast track communication)

  5. 76 FR 22611 - Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic...

    Science.gov (United States)

    2011-04-22

    ... Specified Tax Return Preparers Required To File Individual Income Tax Returns Using Magnetic Media... Register on Wednesday, March 30, 2011 (76 FR 17521) providing guidance to specified tax return preparers who prepare and file individual income tax returns using magnetic media pursuant to section 6011(e)(3...

  6. 27 CFR 479.151 - Failure to make returns: Substitute returns.

    Science.gov (United States)

    2010-04-01

    ... DEVICES, AND CERTAIN OTHER FIREARMS Examination of Books and Records § 479.151 Failure to make returns... return within the time prescribed by this part or designated by the Director, then the return shall be made by an ATF officer upon inspection of the books, but the making of such return by an ATF officer...

  7. Acute Stroke Imaging Research Roadmap

    Science.gov (United States)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Köhrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Wu, Ona; Warach, Steven

    2009-01-01

    The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced neuroimaging in acute stroke treatment. The goals of the meeting were to assess state-of-the-art practice in terms of acute stroke imaging research and to propose specific recommendations regarding: (1) the standardization of perfusion and penumbral imaging techniques, (2) the validation of the accuracy and clinical utility of imaging markers of the ischemic penumbra, (3) the validation of imaging biomarkers relevant to clinical outcomes, and (4) the creation of a central repository to achieve these goals. The present article summarizes these recommendations and examines practical steps to achieve them. PMID:18477656

  8. Auditory Hallucinations in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Yair Lampl

    2005-01-01

    Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

  9. The imaging of ischaemic stroke

    International Nuclear Information System (INIS)

    Hoggard, Nigel; Wilkinson, Iain D.; Griffiths, Paul D.

    2001-01-01

    Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)

  10. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  11. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Haass, A.

    2005-01-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O 2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [de

  12. Endovascular stroke treatment in a small-volume stroke center.

    Science.gov (United States)

    Behzadi, Gry N; Fjetland, Lars; Advani, Rajiv; Kurz, Martin W; Kurz, Kathinka D

    2017-04-01

    Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.

  13. mStroke: "Mobile Stroke"-Improving Acute Stroke Care with Smartphone Technology.

    Science.gov (United States)

    Andrew, Benjamin Y; Stack, Colleen M; Yang, Julian P; Dodds, Jodi A

    2017-07-01

    This study aimed to evaluate the effect of method and time of system activation on clinical metrics in cases utilizing the Stop Stroke (Pulsara, Inc.) mobile acute stroke care coordination application. A retrospective cohort analysis of stroke codes at 12 medical centers using Stop Stroke from March 2013 to May 2016 was performed. Comparison of metrics (door-to-needle time [DTN] and door-to-CT time [DTC], and rate of DTN ≤ 60 minutes [goal DTN]) was performed between subgroups based on method (emergency medical service [EMS] versus emergency department [ED]) and time of activation. Effects were adjusted for confounders (age, sex, National Institutes of Health Stroke Scale [NIHSS] score) using multiple linear and logistic regression. The final dataset included 2589 cases. Cases activated by EMS were more severe (median NIHSS score 8 versus 4, P smartphone technology provides unique insight into acute stroke codes. Activation of mobile electronic stroke coordination in the field appears to promote a more expedited and successful care process. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Cor triatriatum and stroke.

    Science.gov (United States)

    Diestro, Jose Danilo Bengzon; Regaldo, Joseph Justin Hipolito; Gonzales, Eddieson Masangcay; Dorotan, Maria Kristina Casanova; Espiritu, Adrian Isidro; Pascual, Jose Leonard Rivera

    2017-08-08

    Cor triatriatum sinistrum (CTS) is a congenital anomaly where the left atrium is divided into two compartments by a fibromuscular membrane. This report aims to add to the literature on a rare cardiac condition that can cause neurological morbidity. We report a case of a 19-year-old female with an infarct in the right middle cerebral artery (MCA) territory initially maintained on aspirin. Eighteen months later, she had recurrence of weakness, for which repeat transthoracic echocardiography (TTE) and re-evaluation of the first TTE demonstrated a hyperechoic membrane spanning the width of the left atrium, clinching the diagnosis of CTS. Despite anticoagulation with apixaban, she was admitted for a third stroke where she succumbed to hospital-acquired pneumonia. Among cases of CTS associated with stroke, anticoagulation and surgery were the main modes of treatment. This case has the longest follow-up and the first to demonstrate failure of antiplatelet therapy and anticoagulation. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Wen Dan Decoction for hemorrhagic stroke and ischemic stroke.

    Science.gov (United States)

    Xu, Jia-Hua; Huang, Yan-Mei; Ling, Wei; Li, Yang; Wang, Min; Chen, Xiang-Yan; Sui, Yi; Zhao, Hai-Lu

    2015-04-01

    The use of traditional Chinese medicine (TCM) in stroke is increasing worldwide. Here we report the existing clinical evidence of the Pinellia Ternata containing formula Wen Dan Decoction (WDD) for the treatment of ischemic stroke and hemorrhagic stroke. PubMed, CNKI, Wan Fang database, Cochrane Library and online Clinical Trial Registry were searched up to 26 February 2013 for randomized, controlled clinical trials (RCTs) using WDD as intervention versus Western conventional medicine as control to treat stroke. Clinical outcomes were improvement of the Neurological Functional Deficit Scores (NFDS) and overall therapeutic efficacy rates including rate of cure. Meta-regression analysis using Hedges'g was performed for RCTs with significant heterogeneity. A total of 22 RCTs of ischemic stroke and 4 RCTs of hemorrhagic stroke, involving 2214 patients (1167 used WDD), met our inclusion criteria. Meta-analysis of the 13 RCTs reporting NFDS improvement favored WDD over the control (mean difference=-3.40, 95% confidence intervals [CI]=[-4.64, -2.15]). Rate of overall therapeutic efficacy (odds ratio [OR]=3.39, 95%CI=[1.81, 6.37]) for hemorrhagic stroke were significantly higher in WDD treated patients than the control subjects. In the 1898 patients with ischemic stroke, WDD medication also achieved higher rates of cure (OR=2.22, 95%CI=[1.66, 2.97]) and overall therapeutic efficacy (OR=3.31, 95%CI=[2.54, 4.31]) than the conventional treatment. WDD displays benefits on improvement of neurological function and overall therapeutic efficacy in post-stroke patients. TCM such as WDD may serve as a therapeutic tool of dual actions to explore the common mechanisms underlying cerebral hemorrhage and ischemia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was

  17. What about self-management post-stroke? Challenges for stroke survivors, spouses and professionals

    NARCIS (Netherlands)

    Satink, A.J.H.

    2016-01-01

    Self-management post-stroke is challenging for many persons after a stroke. In this thesis is explored how stroke survivors, spouses and professionals perceived self-management post-stroke and how the process of self-management post-stroke evolved over time. The following studies are conducted: a

  18. Stroke, social support and the partner

    NARCIS (Netherlands)

    Kruithof, WJ

    2016-01-01

    Stroke is one of the most common conditions with about 45,000 people suffering a first stroke in the Netherlands each year. Although survival after stroke has increased in recent decades, a substantial part of the survivors of stroke remain physically or cognitively impaired and in need of support

  19. Basic Land Drills for Swimming Stroke Acquisition

    Science.gov (United States)

    Zhang, Peng

    2014-01-01

    Teaching swimming strokes can be a challenging task in physical education. The purpose of the article is to introduce 12 on land drills that can be utilized to facilitate the learning of swimming strokes, including elementary back stroke, sidestroke, front crawl, back stroke, breaststroke, and butterfly. Each drill consists of four components…

  20. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  1. The main components of stroke unit care: results of a European expert survey.

    Science.gov (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner

    2007-01-01

    Stroke units decrease mortality, handicap and need for institutional care, but there are only sparse evidence-based data showing which components make the difference over general wards. The aim of this survey was to identify from expert opinions what should be the major components of stroke units. A questionnaire was sent to 83 European stroke experts, to ask their opinion on what should be the components of comprehensive stroke centres (CSC), primary stroke centres (PSC) and any hospital ward (AHW) admitting acute stroke patients routinely. It consisted of a list of 107 components (personnel, diagnostic procedures, monitoring, invasive treatments provided, infrastructures, protocols and procedures and their availability for 24 h a day for 7 days a week, 24/7) to be classified as irrelevant, useful but not necessary, desirable, important but not absolutely necessary, or absolutely necessary. 42 questionnaires (50.6%) were returned. Four components were excluded because of a poor level of agreement between experts. Eight components were considered as absolutely necessary by more than 75% of the experts for both CSC and PSC: multidisciplinary team, stroke-trained nurses, brain CT scan 24/7, CT priority for stroke patients, extracranial Doppler sonography, automated electrocardiographic monitoring, intravenous rt-PA protocols 24/7 and in-house emergency department. Eleven other components (in the fields of vascular surgery, neurosurgery, interventional radiology and clinical research) were considered as necessary in CSC by more than 75% of the experts. Only 8 components were considered as important but not absolutely necessary by more than 50% of the experts for AHW. The experts showed a high level of agreement about the essential components of organized acute stroke care, providing useful information to health authorities for the allocation of resources. Copyright 2007 S. Karger AG, Basel.

  2. Stroke rehabilitation: recent advances and future therapies.

    LENUS (Irish Health Repository)

    Brewer, L

    2012-09-27

    Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

  3. [Plan for stroke healthcare delivery].

    Science.gov (United States)

    Alvarez Sabín, J; Alonso de Leciñana, M; Gállego, J; Gil-Peralta, A; Casado, I; Castillo, J; Díez Tejedor, E; Gil, A; Jiménez, C; Lago, A; Martínez-Vila, E; Ortega, A; Rebollo, M; Rubio, F

    2006-12-01

    All stroke patients should receive the same degree of specialized healthcare attention according to the stage of their disease, independently of where they live, their age, gender or ethnicity. To create an organized healthcare system able to offer the needed care for each patient, optimizing the use of the existing resource. A committee of 14 neurologists specialized in neurovascular diseases representing different regions of Spain evaluated the available scientific evidence according to the published literature. During the acute phase, all stroke patients must be evaluated in hospitals that offer access to specialized physicians (neurologists) and the indicated diagnostic and therapeutic procedures. Hospitals that deliver care to acute stroke patients must be prepared to attend these patients and need to arrange a predefined transferring circuit coordinated with the extrahospitalary emergency service. Since resources are limited, they should be structured into different care levels according to the target population. Thus, three types of hospitals will be defined for stroke care: reference stroke hospital, hospital with stroke unit, hospital with stroke team.

  4. Cognitive performance after ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Maria Gabriela R. Ferreira

    Full Text Available Cognitive impairment after stroke affects the patient recovery process. Therefore, the identification of factors associated with cognitive outcomes is important since it allows risk profiles of stroke survivors to be determined. OBJECTIVE: To assess cognitive outcome of stroke outpatients and investigate associations among clinical and demographic variables, vascular risk factors, depression symptoms and functional ability; and to describe the neuropsychological profile of these patients. METHODS: A cross-sectional design study was conducted. Subjects who suffered a first-ever ischaemic stroke 6 to 10 months prior to data collection underwent neuropsychological assessment and screening for depressive symptoms and functional ability. The outcome "cognitive performance" was analyzed considering two groups: "cognitive impairment" and "no cognitive impairment". RESULTS: There was a statistically significant association between cognitive impairment and female gender, age, stroke severity and functional ability. Regarding neuropsychological profile, the cognitive impairment group exhibited more generalized deficits in attention, visuospatial organization, verbal functions and verbal memory domains compared to the community control group. CONCLUSION: The occurrence of cognitive impairment among patients was high, especially in women, older participants, individuals with more severe stroke, and greater impairment in functional ability. Multiple cognitive domains are affected and this may hamper recovery and negatively impact independence and quality of life after stroke.

  5. A questionnaire to assess carers' experience of stroke rehabilitation.

    Science.gov (United States)

    Howells, Amy; Morris, Reg; Darwin, Cressida

    2012-01-01

    To establish the validity and reliability of a questionnaire measuring the experience of informal carers of patients with stroke through acute and rehabilitation hospital treatment. The settings were 6 stroke units in the United Kingdom. Participants were relatives of patients with stroke. The Stroke Carer Experience Questionnaire (SCEQ) asks about specific elements of care and was constructed using qualitative analyses. Convergent and discriminant validity were assessed by correlations with other questionnaires and variables. Criterion validity was examined by correlations with indices derived from qualitative data. Temporal stability was assessed by correlation with a repeated administration. The performance of the questionnaire was compared with that of the Carer Hospital Satisfaction Questionnaire (Carer HospSat). Seventy-two (49%) of 147 questionnaires were returned. Test-retest reliability, assessed by a questionnaire mailed 7 days after the first completion, was 0.77. The correlation with the Carer HospSat was 0.57, indicating convergent validity. The SCEQ did not correlate with demographic variables or functional ability, which indicated discriminant validity. Significant correlations with indices derived from carers' qualitative descriptions evidenced criterion validity. The SCEQ detected specific negative experiences among carers with high global satisfaction scores on the Carer HospSat. In general, the SCEQ items were not strongly intercorrelated; only 6% of the intercorrelations were strong to moderate (30.6). The SCEQ is preferable to existing questionnaires for carers of patients with stroke, because it has established validity and reliability and assesses service characteristics important to carers. It also identifies experiences in services that elude global satisfaction ratings. It is a promising instrument for identifying service strengths and unmet needs.

  6. Acupuncture for acute stroke.

    Science.gov (United States)

    Xu, Mangmang; Li, Dan; Zhang, Shihong

    2018-03-30

    Sensory stimulation via acupuncture has been reported to alter activities of numerous neural systems by activating multiple efferent pathways. Acupuncture, one of the main physical therapies in Traditional Chinese Medicine, has been widely used to treat patients with stroke for over hundreds of years. This is the first update of the Cochrane Review originally published in 2005. To assess whether acupuncture could reduce the proportion of people with death or dependency, while improving quality of life, after acute ischemic or hemorrhagic stroke. We searched the Cochrane Stroke Group trials register (last searched on February 2, 2017), the Cochrane Central Register of Controlled Trials Ovid (CENTRAL Ovid; 2017, Issue 2) in the Cochrane Library, MEDLINE Ovid (1946 to February 2017), Embase Ovid (1974 to February 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO (1982 to February 2017), the Allied and Complementary Medicine Database (AMED; 1985 to February 2017), China Academic Journal Network Publishing Database (1998 to February 2017), and the VIP database (VIP Chinese Science Journal Evaluation Reports; 1989 to February 2017). We also identified relevant trials in the Chinese Clinical Trial Registry (last searched on Feburuary 20, 2017), the World Health Organization (WHO) International Clinical Trials Registry Platform (last searched on April 30, 2017), and Clinicaltrials.gov (last searched on April 30, 2017). In addition, we handsearched the reference lists of systematic reviews and relevant clinical trials. We sought randomized clinical trials (RCTs) of acupuncture started within 30 days from stroke onset compared with placebo or sham acupuncture or open control (no placebo) in people with acute ischemic or hemorrhagic stroke, or both. Needling into the skin was required for acupuncture. Comparisons were made versus (1) all controls (open control or sham acupuncture), and (2) sham acupuncture controls. Two review authors applied

  7. Sudden unexpected death caused by stroke

    DEFF Research Database (Denmark)

    Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára

    2018-01-01

    Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke....... Increased awareness among healthcare professionals towards stroke symptoms in children and young adults may lead to earlier detection of stroke, and thereby potentially lowering the incidence of sudden death by stroke....

  8. Editorial for the Third Pangu Stroke Conference.

    Science.gov (United States)

    Chen, Gang; Chen, Jun; Ji, Xunming; Xi, Guohua; Zhang, John

    2015-10-01

    The Pangu Stroke Conference has been held annually in China since 2012 and is based on the successful templates of the Princeton Stroke Conference in the United States and the Marburg Conference on Cerebral Ischemia in Germany. All participants in the Pangu Stroke Conference are expert stroke clinicians or stroke basic science researchers of Chinese origin. This conference promotes collaboration between clinicians and basic science researchers and between stroke researchers in mainland China and other parts of the world. The Pangu Stroke Conference fosters translational stroke research, discussions of stroke research milestones, and proposals for future directions. Some of the keynote presentations in the third Pangu Stroke Conference are included in this special issue. Copyright © 2015. Published by Elsevier Inc.

  9. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik

    2011-01-01

    GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...... months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were...

  10. Specific antismoking advice after stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete; Larsen, Klaus; Brink-Kjær, Tove

    2014-01-01

    INTRODUCTION: Many stroke survivors would benefit from modification of their lifestyle in order to reduce their risk of recurrent stroke. We investigated if tailored smoking cessation advice would yield a higher smoking cessation rate and a higher rate with sustained abstinence in ex......-smokers in the intervention group than among controls. MATERIAL AND METHODS: Patients admitted with an acute stroke or a transient ischaemic attack were included in a randomised controlled trial focusing on control of lifestyle risk factors and hypertension. Here, we report the intervention focused on smoking cessation. We...

  11. Strokes in young adults: epidemiology and prevention

    Directory of Open Access Journals (Sweden)

    Smajlović D

    2015-02-01

    Full Text Available Dževdet Smajlović Department of Neurology, University Clinical Centre Tuzla, School of Medicine, University of Tuzla, Bosnia and Herzegovina Abstract: Strokes in young adults are reported as being uncommon, comprising 10%–15% of all stroke patients. However, compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults. This is important given the fact that younger stroke patients have a clearly increased risk of death compared with the general population. The prevalence of standard modifiable vascular risk factors in young stroke patients is different from that in older patients. Modifiable risk factors for stroke, such as dyslipidemia, smoking, and hypertension, are highly prevalent in the young stroke population, with no significant difference in geographic, climatic, nutritional, lifestyle, or genetic diversity. The list of potential stroke etiologies among young adults is extensive. Strokes of undetermined and of other determined etiology are the most common types among young patients according to TOAST (Trial of Org 10172 in Acute Stroke Treatment criteria. Prevention is the primary treatment strategy aimed at reducing morbidity and mortality related to stroke. Therefore, primary prevention is very important with regard to stroke in young adults, and aggressive treatment of risk factors for stroke, such as hypertension, smoking, and dyslipidemia, is essential. The best form of secondary stroke prevention is directed toward stroke etiology as well as treatment of additional risk factors. However, there is a lack of specific recommendations and guidelines for stroke management in young adults. In conclusion, strokes in young adults are a major public health problem and further research, with standardized methodology, is needed in order to give us more

  12. The PRE-hospital Stroke Treatment Organization.

    Science.gov (United States)

    Audebert, Heinrich; Fassbender, Klaus; Hussain, M Shazam; Ebinger, Martin; Turc, Guillaume; Uchino, Ken; Davis, Stephen; Alexandrov, Anne; Grotta, James

    2017-12-01

    Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRE-hospital Stroke Treatment Organization will also facilitate the appropriate proliferation and distribution of Mobile Stroke Units by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support. Summary of review In this "white paper", we describe the evidence supporting pre-hospital stroke treatment, progress to date, practical issues such as application in various environments and staffing, planned research initiatives, and organizational structure. Conclusions PRE-hospital Stroke Treatment Organization is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRE-hospital Stroke Treatment Organization has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a Mobile Stroke Unit in operation. PRE-hospital Stroke Treatment Organization convenes satellite meetings for membership at the International Stroke Conference and European Stroke Congress each year to address the PRE-hospital Stroke Treatment Organization mission. The first research collaborations agreed upon are to: (1) develop a list of common data elements to be collected by all Mobile Stroke Unit programs and entered into a common research database, and (2) develop a protocol for investigating the natural history of hyper-acute Intracerebral Hemorrhage.

  13. Recovery of Dysphagia in Lateral Medullary Stroke

    OpenAIRE

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia...

  14. Sex-specific responses to stroke

    OpenAIRE

    Turtzo, L Christine; McCullough, Louise D

    2010-01-01

    Stroke is a sexually dimorphic disease, with differences between males and females observed both clinically and in the laboratory. While males have a higher incidence of stroke throughout much of the lifespan, aged females have a higher burden of stroke. Sex differences in stroke result from a combination of factors, including elements intrinsic to the sex chromosomes as well as the effects of sex hormone exposure throughout the lifespan. Research investigating the sexual dimorphism of stroke...

  15. Interday drifts in opening stock returns

    OpenAIRE

    Andrey KUDRYAVTSEV

    2013-01-01

    In present study, I make an effort to shed light on the actual mechanism of autocorrelations in individual stocks' opening returns. I analyze intraday price data on thirty stocks currently making up the Dow Jones Industrial Index. Employing the sample average and the sample median of opening stock returns for each of the trading days within the sample period as two alternative proxies for the general market opening returns, I document that if the previous day's market and individual stock's o...

  16. Return to Sport After Tibial Shaft Fractures

    OpenAIRE

    Robertson, Greg A. J.; Wood, Alexander M.

    2015-01-01

    Context: Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. Objective: To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. Data Sources: OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Sch...

  17. Analysis of medications returned to community pharmacies.

    Science.gov (United States)

    James, Tess H; Helms, Margaret L; Braund, Rhiannon

    2009-10-01

    There are many causes of medication waste, including excess supply, treatment changes, and patient nonadherence to therapy. Investigating medication returns may indicate areas for targeting interventions to reduce waste. To identify and quantify the types and amounts of medications returned to community pharmacies and, specifically, to quantify the percentage of medication returned from the original dispensing, its therapeutic category, and reasons for not being used. Unsolicited medication returned for disposal to the 24 community pharmacies in the Taranaki region (approximately 37,000 households) of New Zealand over a 6-week period was analyzed. The results were entered into a database, recording medication, amount originally issued (if known), date of issue, Anatomical Therapeutic Chemical (ATC) classification, and reason for nonuse. Cross-tabulation of ATC category versus percentage returned as well as ATC category versus reason for returns was performed. Adjusted standardized residuals were investigated to determine specific cells that were in excess of the expected counts. Complete information was available for 2704 items. The majority (51%) of returns contained 75-100% of the original dispensed amount of medication. For the respiratory category, 77% of the returns were in the 75-100% group, significantly more than for any other therapeutic group. Reasons for returns were recorded as bereavement (22%), surplus to requirements (17%), expired (8%), medication change (11%), dose change (3%), and unknown (39%). The cardiovascular group and respiratory groups had a higher rate of returned drugs due to medication changes and surplus to requirements, respectively. The majority of returned medications contained greater than 75% of the original amount issued. Identification of therapeutic groups having higher rates of returns due to medication changes or surplus to requirements may suggest areas to target to reduce medication waste.

  18. Stroke subtypes and factors associated with ischemic stroke in ...

    African Journals Online (AJOL)

    . Better understanding and controlling factors associated will improve the prevention of the disease. This study reviews records of patients with ischemic stroke in Central Africa. Material and methods: Patients of Bantu ethnicity with clinical ...

  19. [Post-stroke apathy].

    Science.gov (United States)

    López-Dóriga Bonnardeaux, Pedro; Andrino Díaz, Nuria

    2016-01-01

    Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  20. The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Brasier, Catherine; Ski, Chantal F; Thompson, David R; Cameron, Jan; O'Brien, Casey L; Lautenschlager, Nicola T; Gonzales, Graeme; Hsueh, Ya-Seng Arthur; Moore, Gaye; Knowles, Simon R; Rossell, Susan L; Haselden, Rachel; Castle, David J

    2016-09-09

    Stroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers. This study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted. We believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management. ACTRN12615001046594 . Registered on 7 October 2015.

  1. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes.

    Science.gov (United States)

    Rebello, L C; Bouslama, M; Haussen, D C; Grossberg, J A; Dehkharghani, S; Anderson, A; Belagaje, S R; Bianchi, N A; Grigoryan, M; Frankel, M R; Nogueira, R G

    2017-06-01

    Chronic hypoperfusion from athero-stenotic lesions is thought to lead to better collateral recruitment compared to cardioembolic strokes. It was sought to compare collateral flow in stroke patients with atrial fibrillation (AF) versus stroke patients with cervical atherosclerotic steno-occlusive disease (CASOD). This was a retrospective review of a prospectively collected endovascular database. Patients with (i) anterior circulation large vessel occlusion stroke, (ii) pre-treatment computed tomography angiography (CTA) and (iii) intracranial embolism from AF or CASOD were included. CTA collateral patterns were evaluated and categorized into two groups: absent/poor collaterals (CTA collateral score 0-1) versus moderate/good collaterals (CTA collateral score 2-4). CT perfusion was also utilized for baseline core volume and evaluation of infarct growth. A total of 122 patients fitted the inclusion criteria, of whom 88 (72%) had AF and 34 (27%) CASOD. Patients with AF were older (P Collateral scores were lower in the AF group (P = 0.01) with patients having poor collaterals in 28% of cases versus 9% in the CASOD group (P = 0.03). Mortality rates (20% vs. 0%; P = 0.02) were higher in the AF patients whilst rates of any parenchymal hemorrhage (6% vs. 26%; P collaterals (odds ratio 4.70; 95% confidence interval 1.17-18.79; P = 0.03). Atheroembolic strokes seem to be associated with better collateral flow compared to cardioembolic strokes. This may in part explain the worse outcomes of AF-related stroke. © 2017 EAN.

  2. Stroke Laterality Bias in the Management of Acute Ischemic Stroke.

    Science.gov (United States)

    McCluskey, Gavin; Wade, Carrie; McKee, Jacqueline; McCarron, Peter; McVerry, Ferghal; McCarron, Mark O

    2016-11-01

    Little is known of the impact of stroke laterality on the management process and outcome of patients with acute ischemic stroke (AIS). Consecutive patients admitted to a general hospital over 1 year with supratentorial AIS were eligible for inclusion in the study. Baseline characteristics and risk factors, delays in hospital admission, imaging, intrahospital transfer to an acute stoke unit, stroke severity and classification, length of hospital admission, as well as 10-year mortality were measured and compared among right and left hemisphere AIS patients. There were 141 patients (77 men, 64 women; median age 73 [interquartile range 63-79] years), There were 71 patients with left hemisphere AIS and 70 with right hemisphere AIS. Delays to hospital admission from stroke onset to neuroimaging were similar among right and left hemisphere AIS patients. Delay in transfer to an acute stroke unit (ASU) following hospital admission was on average 14 hours more for right hemisphere compared to left hemisphere AIS patients (P = .01). Laterality was not associated with any difference in 10-year survival. Patients with mild and nondominant AIS merit particular attention to minimize their intrahospital transfer time to an ASU. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. RODENT STROKE MODEL GUIDELINES FOR PRECLINICAL STROKE TRIALS (1ST EDITION)

    OpenAIRE

    Liu, Shimin; Zhen, Gehua; Meloni, Bruno P.; Campbell, Kym; Winn, H Richard

    2009-01-01

    Translational stroke research is a challenging task that needs long term team work of the stroke research community. Highly reproducible stroke models with excellent outcome consistence are essential for obtaining useful data from preclinical stroke trials as well as for improving inter-lab comparability. However, our review of literature shows that the infarct variation coefficient of commonly performed stroke models ranges from 5% to 200%. An overall improvement of the commonly used stroke ...

  4. Training the brain to survive stroke.

    Directory of Open Access Journals (Sweden)

    Jeff F Dunn

    Full Text Available Presently, little can be done to repair brain tissue after stroke damage. We hypothesized that the mammalian brain has an intrinsic capacity to adapt to low oxygen which would improve outcome from a reversible hypoxic/ischemic episode. Acclimation to chronic hypoxia causes increased capillarity and tissue oxygen levels which may improve the capacity to survive ischemia. Identification of these adaptations will lead to protocols which high risk groups could use to improve recovery and reduce costs.Rats were exposed to hypoxia (3 weeks living at ½ an atmosphere. After acclimation, capillary density was measured morphometrically and was increased by 30% in the cortex. Novel implantable oxygen sensors showed that partial pressure of oxygen in the brain was increased by 40% in the normal cortex. Infarcts were induced in brain with 1 h reversible middle cerebral artery occlusions. After ischemia (48 h behavioural scores were improved and T2 weighted MRI lesion volumes were reduced by 52% in acclimated groups. There was a reduction in inflammation indicated by reduced lymphocytes (by 27-33%, and ED1 positive cells (by 35-45%.It is possible to stimulate a natural adaptive mechanism in the brain which will reduce damage and improve outcome for a given ischemic event. Since these adaptations occur after factors such as HIF-1α have returned to baseline, protection is likely related more to morphological changes such as angiogenesis. Such pre-conditioning, perhaps with exercise or pharmaceuticals, would not necessarily reduce the incidence of stroke, but the severity of damage could be reduced by 50%.

  5. [The importance of neuronal networks for motor rehabilitation after a stroke].

    Science.gov (United States)

    Hummel, F C

    2017-08-01

    Every year in Europe 1.5 million patients suffer a new stroke. Despite the further developments in acute therapy with nationwide stroke units, thrombolysis, thrombectomy and post-acute neurorehabilitation, only a small proportion of patients recover to a satisfactory degree allowing them to return to their normal social and professional life. This makes stroke the main cause of long-term disability with a corresponding impact on patient lives, socioeconomics and the healthcare system. Thus, the concepts of neurorehabilitation have to be extended to enhance the effects of rehabilitative treatment strategies. To achieve this, an understanding of the prediction of the course of recovery, the mechanisms underlying functional recovery and factors influencing recovery have to be enhanced for the development towards patient-tailored precision medicine approaches. A central point towards this is the understanding of stroke as a disease, which not only influences the damaged area but also the associated network. This is crucial for the understanding of the stroke-induced deficits, for prediction of recovery and options for interventional treatment strategies, which can target different areas in this network (e.g. primary motor cortex and secondary motor regions) based on individual factors of the patient. The present article discusses the importance of network alterations for motor neurorehabilitation after a stroke and which novel options, concepts and consequences could arise from this for neurorehabilitation.

  6. Measurement of confidence: the development and psychometric evaluation of a stroke-specific, measure of confidence.

    Science.gov (United States)

    Horne, Jane C; Lincoln, Nadina B; Logan, Pip A

    2017-11-01

    To design, develop and psychometrically evaluate a stroke-specific measure of confidence, the Confidence after Stroke Measure (CaSM). Cross-sectional. Adults in the community. Stroke survivors and healthy elderly participants. Questionnaire items were generated based on the literature and qualitative interviews and piloted with expert groups to establish face validity. A 53-item CaSM was administered to stroke survivors and healthy elderly participants in the community. A second copy was posted four weeks later. Completed questionnaires were analysed for extreme responses, missing values, construct validity (factor analysis), convergent validity, divergent validity, reliability (internal consistency and temporal stability) and comparing responses according to age and gender. Stroke ( n = 101) and healthy elderly participants ( n = 101) returned questionnaires. Eight items were removed that had extreme responses and large numbers of missing values. Six items had item total correlations Confidence, Positive Attitude and Social Confidence, which explained 52% of variance. Cronbach's alpha coefficient demonstrated good internal consistency ( α = 0.94). A test re-test on the 27 items indicated good temporal stability ( r = 0.85, P = 0.001). The 27-item CaSM was a valid and reliable measure for assessing confidence in stroke survivors.

  7. Magnetic Resonance Imaging of Stroke

    NARCIS (Netherlands)

    Bouts, Mark. J. R. J.; Wu, O.; Dijkhuizen, R. M.

    2017-01-01

    Magnetic resonance imaging (MRI) provides a powerful (neuro)imaging modality for the diagnosis and outcome prediction after (acute) stroke. Since MRI allows noninvasive, longitudinal, and three-dimensional assessment of vessel occlusion (with magnetic resonance angiography (MRA)), tissue injury

  8. Genetic View To Stroke Occurrence

    Directory of Open Access Journals (Sweden)

    Sadegh Yoosefee

    2017-02-01

    Full Text Available Stroke is the third leading cause of death. The role of genetics in the etiology and development of this disease is undeniable. As a result of inadequate previous research, more and more studies in the field of genetics are necessary to identify pathways involved in the pathogenesis of stroke, which in turn, may lead to new therapeutic approaches. However, due to the multifactorial nature of stroke and the few studies conducted in this field, genetic diversity is able to predict only a small fraction of the risk of disease. On the other hand, studies have shown genetically different architecture for different types of stroke, and finally pharmacogenomics as an important part of personalized medicine approach, is influenced by genetic studies, all of which confirm the need of addressing the topic by researchers.

  9. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... mortality statistics found in the Heart Disease & Stroke Statistics Update . Because mortality is considered "hard" data, it's possible to do time-trend analysis and compute percent changes over time. What are ...

  10. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... of infarcts. For a number of years, tight glycemic control has been regarded as beneficial in critically illness, but recent research has been unable to support this notion. The only completed randomized study on glucose-lowering therapy in stroke has failed to demonstrate effect, and concerns relating...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  11. Maximizing your return on people.

    Science.gov (United States)

    Bassi, Laurie; McMurrer, Daniel

    2007-03-01

    Though most traditional HR performance metrics don't predict organizational performance, alternatives simply have not existed--until now. During the past ten years, researchers Laurie Bassi and Daniel McMurrer have worked to develop a system that allows executives to assess human capital management (HCM) and to use those metrics both to predict organizational performance and to guide organizations' investments in people. The new framework is based on a core set of HCM drivers that fall into five major categories: leadership practices, employee engagement, knowledge accessibility, workforce optimization, and organizational learning capacity. By employing rigorously designed surveys to score a company on the range of HCM practices across the five categories, it's possible to benchmark organizational HCM capabilities, identify HCM strengths and weaknesses, and link improvements or back-sliding in specific HCM practices with improvements or shortcomings in organizational performance. The process requires determining a "maturity" score for each practice, based on a scale of 1 (low) to 5 (high). Over time, evolving maturity scores from multiple surveys can reveal progress in each of the HCM practices and help a company decide where to focus improvement efforts that will have a direct impact on performance. The authors draw from their work with American Standard, South Carolina's Beaufort County School District, and a bevy of financial firms to show how improving HCM scores led to increased sales, safety, academic test scores, and stock returns. Bassi and McMurrer urge HR departments to move beyond the usual metrics and begin using HCM measurement tools to gauge how well people are managed and developed throughout the organization. In this new role, according to the authors, HR can take on strategic responsibility and ensure that superior human capital management becomes central to the organization's culture.

  12. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  13. Expected Stock Returns and Variance Risk Premia

    DEFF Research Database (Denmark)

    Bollerslev, Tim; Tauchen, George; Zhou, Hao

    of the time series variation in post 1990 aggregate stock market returns, with high (low) premia predicting high (low) future returns. Our empirical results depend crucially on the use of "model-free," as opposed to Black- Scholes, options implied volatilities, along with accurate realized variation measures...

  14. A Perishable Inventory Model with Return

    Science.gov (United States)

    Setiawan, S. W.; Lesmono, D.; Limansyah, T.

    2018-04-01

    In this paper, we develop a mathematical model for a perishable inventory with return by assuming deterministic demand and inventory dependent demand. By inventory dependent demand, it means that demand at certain time depends on the available inventory at that time with certain rate. In dealing with perishable items, we should consider deteriorating rate factor that corresponds to the decreasing quality of goods. There are also costs involved in this model such as purchasing, ordering, holding, shortage (backordering) and returning costs. These costs compose the total costs in the model that we want to minimize. In the model we seek for the optimal return time and order quantity. We assume that after some period of time, called return time, perishable items can be returned to the supplier at some returning costs. The supplier will then replace them in the next delivery. Some numerical experiments are given to illustrate our model and sensitivity analysis is performed as well. We found that as the deteriorating rate increases, returning time becomes shorter, the optimal order quantity and total cost increases. When considering the inventory-dependent demand factor, we found that as this factor increases, assuming a certain deteriorating rate, returning time becomes shorter, optimal order quantity becomes larger and the total cost increases.

  15. Return to Experience and Initial Wage Level

    DEFF Research Database (Denmark)

    Sørensen, Kenneth Lykke; Vejlin, Rune Majlund

    This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to nonparametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationship...

  16. Return to experience and initial wage level

    DEFF Research Database (Denmark)

    Sørensen, K.L.; Vejlin, R.

    2014-01-01

    This paper estimates the relationship between initial wage and return to experience. We use a Mincer-like wage model to non-parametrically estimate this relationship allowing for an unobservable individual permanent effect in wages and unobservable individual return to experience. The relationshi...

  17. Return to the workforce following infective endocarditis

    DEFF Research Database (Denmark)

    Butt, Jawad H.; Kragholm, Kristian; Dalager-Pedersen, Michael

    2018-01-01

    Background The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age. Methods Using Danish...

  18. LITTERFALL AND NUTRIENT RETURNS IN ISOLATED STANDS ...

    African Journals Online (AJOL)

    Dr Osondu

    area has implications in returning nutrient elements to the soils of the rainforest ecosystem. Keywords: Litterfall, Nutrient returns, Seasonal variation, Southern Nigeria, Terminalia catappa, Tropical rainforest. Introduction. In the tropical rainforests, plants and soils are in equilibrium involving an almost closed cycling.

  19. Social return bij inkoop door gemeenten

    NARCIS (Netherlands)

    Brouwer, P.; Smit, A.

    2011-01-01

    Social return is sterk in opkomst. De rijksoverheid heeft besloten om met ingang van 1 juli 2011 bij inkopen en aanbestedingen ‘social return’ als contractvoorwaarde op te nemen. Het Brabants Expertisecentrum Socialer Ondernemen (BESO) bracht in dezelfde periode de handleiding ‘Social return bij

  20. Predictability of Returns and Cash Flows

    OpenAIRE

    Ralph S.J. Koijen; Stijn Van Nieuwerburgh

    2010-01-01

    We review the literature on return and cash-flow growth predictability from the perspective of the present-value identity. We focus predominantly on recent work. Our emphasis is on U.S. aggregate stock return predictability, but we also discuss evidence from other asset classes and countries.